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General NPI Number Information
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NPI Number | 1700941580
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Entity Type | Organization
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Legal Business Name | RESCARE
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 205 MONTVUE DR
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City | LEWISBURG
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State | WV
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Zip | 24901-8929
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Country | US
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Telephone | 304-645-4215
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Fax |
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Provider Business Mailing Address
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Address Line | 208 S COURT ST
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City | LEWISBURG
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State | WV
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Zip | 24901-1310
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHRISTINE SHAW
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Credential |
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Telephone | 304-645-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 330
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License Number State | WV
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