1780682088 NPI number — NELLA'S NURSING HOME, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780682088 NPI number — NELLA'S NURSING HOME, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NELLA'S NURSING HOME, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780682088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26241-1399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-636-2033
Provider Business Mailing Address Fax Number:
304-637-6206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 WHITEMAN AVE
Provider Second Line Business Practice Location Address:
CRYSTAL SPRINGS
Provider Business Practice Location Address City Name:
ELKINS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26241-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-636-2033
Provider Business Practice Location Address Fax Number:
304-637-6206
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HYSON
Authorized Official First Name:
SHASTA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
304-636-2033

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  17 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com