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General NPI Number Information
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NPI Number | 1417963000
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Entity Type | Organization
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Legal Business Name | WVDHHR JOHN MANCHIN SR HEALTH CARE CENTER
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 401 GUFFEY STREET
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City | FAIRMONT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-363-2500
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Fax | 304-363-0263
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Provider Business Mailing Address
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Address Line | 401 GUFFEY STREET
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City | FAIRMONT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-363-2500
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Fax | 304-363-0263
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Authorized Official
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Title or Position | CEO ADMINISTRATOR
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Name | MS. CAROL D MERRILL
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Credential | NHA
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Telephone | 304-363-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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