MEDICARE: MOUND VIEW HEALTH CARE, 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	314000000X	Skilled Nursing Facility	75	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	:	1902802259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUND VIEW HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	2200 FLORAL ST
Second Line	:
City	:	MOUNDSVILLE
State	:	WV
Zip	:	26041-1293
Country	:	US
Telephone Number	:
Fax Number	:	304-843-1504

Provider Business Practice Location Address
First Line	:	2200 FLORAL ST
Second Line	:
City	:	MOUNDSVILLE
State	:	WV
Zip	:	26041-1293
Country	:	US
Telephone Number	:	304-843-1035
Fax Number	:	304-843-1504

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. KONSTANTIN DOLGOVSKIJ
Credential	:
Telephone Number	:	304-843-1035

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/22/2020

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