=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841465473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELKINS REGIONAL CONVALESCENT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1175 BEVERLY PIKE
-----------------------------------------------------
City | ELKINS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26241-9759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-636-1391
-----------------------------------------------------
Fax | 304-636-1371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 BEVERLY PIKE
-----------------------------------------------------
City | ELKINS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26241-9759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-636-1391
-----------------------------------------------------
Fax | 304-636-1371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. CAROL M MORRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-636-1391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 134
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------