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General NPI Number Information
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NPI Number | 1053542555
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Entity Type | Organization
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Legal Business Name | ARBORS OF FAIRMONT
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 1700 BIG TREE DR APT 79
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City | FAIRMONT
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State | WV
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Zip | 26554-8310
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Country | US
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Telephone | 304-476-8053
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 BIG TREE DR APT 79
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City | FAIRMONT
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State | WV
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Zip | 26554-8310
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Country | US
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Telephone | 304-476-8053
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Fax |
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Authorized Official
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Title or Position | PTA
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Name | LAUREN N COFFINDAFFER
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Credential |
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Telephone | 304-476-8053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1393
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License Number State | WV
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