Healthcare Provider Details

I. General information

NPI: 1730177130
Provider Name (Legal Business Name): MINGO CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HILLCREST DR
WILLIAMSON WV
25661-3948
US

IV. Provider business mailing address

100 HILLCREST DR
WILLIAMSON WV
25661-3948
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-7005
  • Fax: 304-752-8768
Mailing address:
  • Phone: 304-235-7005
  • Fax: 304-752-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number92
License Number StateWV

VIII. Authorized Official

Name: MR. THOMAS SPHATT
Title or Position: CHIEF OF OPERATIONS & FINANCE
Credential:
Phone: 304-752-8761