| NPI | 1922406602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE A PACK Manager 304-343-1950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2022-05-18 |