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General NPI Number Information
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NPI Number | 1730439860
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Entity Type | Organization
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Legal Business Name | MAIN STREET HINTON
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 1500 TERRACE ST SUITE 300
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City | HINTON
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State | WV
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Zip | 25951-9768
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Country | US
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Telephone | 304-466-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 TERRACE ST SUITE 300
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City | HINTON
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State | WV
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Zip | 25951-9768
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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 | BOARD PRESIDENT
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Name | MARY LOU HALEY
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Credential |
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Telephone | 304-466-5332
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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 | WV
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