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General NPI Number Information
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NPI Number | 1538427075
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Entity Type | Organization
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Legal Business Name | WINDY HILL VILLAGE
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 17024 VETERANS MEMORIAL HWY
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City | KINGWOOD
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State | WV
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Zip | 26537-8013
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Country | US
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Telephone | 304-329-2741
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Fax |
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Provider Business Mailing Address
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Address Line | 17024 VETERANS MEMORIAL HWY
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City | KINGWOOD
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State | WV
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Zip | 26537-8013
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Country | US
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Telephone | 304-329-2741
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Fax | 304-329-2744
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARK THOMAS SQUIRES
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Credential |
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Telephone | 304-329-2741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 506117
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License Number State | WV
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