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General NPI Number Information
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NPI Number | 1689084790
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Entity Type | Organization
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Legal Business Name | JAY WYN L.L.C
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 610 NORTH 10TH STREET
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City | WEIRTON
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State | WV
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Zip | 26062
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Country | US
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Telephone | 304-748-3943
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Fax | 304-748-3944
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Provider Business Mailing Address
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Address Line | P.O. BOX 102
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City | FOLLANSBEE
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State | WV
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Zip | 26062
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Country | US
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Telephone | 304-527-5400
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Fax | 304-527-5455
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. TAMELA SUE MCQUISTON
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Credential |
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Telephone | 304-231-4938
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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 | 507574
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License Number State | WV
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