Provider Demographics
NPI:1003813510
Name:NELLAS INC
Entity Type:Organization
Organization Name:NELLAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:EIDELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:304-636-1008
Mailing Address - Street 1:PO BOX 1639
Mailing Address - Street 2:FERGUSON ROAD, BLDG 1
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1639
Mailing Address - Country:US
Mailing Address - Phone:304-636-1008
Mailing Address - Fax:304-637-6106
Practice Address - Street 1:FERGUSON ROAD, BLDG 1
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-1639
Practice Address - Country:US
Practice Address - Phone:304-636-1008
Practice Address - Fax:304-637-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003795000Medicaid