MEDICARE: REM WV, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility		WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740306547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REM WV, INC.

Provider Business Mailing Address
First Line	:	748 MCMECHEN ST
Second Line	:
City	:	BENWOOD
State	:	WV
Zip	:	26031-1100
Country	:	US
Telephone Number	:	304-233-2141
Fax Number	:	304-233-3558

Provider Business Practice Location Address
First Line	:	170 PADUCAH DR
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-2710
Country	:	US
Telephone Number	:	304-455-4804
Fax Number	:	304-455-3786

Authorized Official
Title or Position	:	COO
Name	:	BRETT IAN COHEN
Credential	:
Telephone Number	:	800-388-5150

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	04/20/2023

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