Basic Information
| Provider Information | |||||||||
| NPI: | 1366506941 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RSCR WEST VIRGINIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9901 LINN STATION ROAD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023942100 | ||||||||
| FaxNumber: | 5023942285 | ||||||||
| Practice Location | |||||||||
| Address1: | RR 6 BOX 454 | ||||||||
| Address2: | |||||||||
| City: | BUCKHANNON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 262018839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044725503 | ||||||||
| FaxNumber: | 3044725503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 06/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | OMBRES | ||||||||
| AuthorizedOfficialFirstName: | DEENA | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE GENERAL COUNSEL & PRIVACY | ||||||||
| AuthorizedOfficialTelephone: | 5023942387 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | ESQ. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315P00000X | 44 | WV | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded |
ID Information
| ID | Type | State | Issuer | Description | 0003179000 | 05 | WV | MEDICAID |