Basic Information
| Provider Information | |||||||||
| NPI: | 1134119555 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WORTHINGTON NURSING & REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2675 36TH ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261048024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044485744 | ||||||||
| FaxNumber: | 3044859344 | ||||||||
| Practice Location | |||||||||
| Address1: | 2675 36TH ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261048024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044857447 | ||||||||
| FaxNumber: | 3044859344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 12/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | ORLINSKY | ||||||||
| AuthorizedOfficialFirstName: | MOSHE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3145887518 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 56 | WV | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0003905000 | 05 | WV | MEDICAID |