Basic Information
| Provider Information | |||||||||
| NPI: | 1295899169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESCARE WEST VIRGINIA, INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1618 BUCKHANNON PIKE | ||||||||
| Address2: | |||||||||
| City: | NUTTER FORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263014465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043260140 | ||||||||
| FaxNumber: | 3043260152 | ||||||||
| Practice Location | |||||||||
| Address1: | 281 S MONTICELLO AVE | ||||||||
| Address2: | |||||||||
| City: | CLARKSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263013037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046232947 | ||||||||
| FaxNumber: | 3046232951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CANFIELD | ||||||||
| AuthorizedOfficialFirstName: | JACKIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3043260140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315P00000X | 329 | WV | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded |
No ID Information.