Provider Demographics
NPI:1134119555
Name:WORTHINGTON NURSING & REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:WORTHINGTON NURSING & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-588-7518
Mailing Address - Street 1:2675 36TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-8024
Mailing Address - Country:US
Mailing Address - Phone:304-448-5744
Mailing Address - Fax:304-485-9344
Practice Address - Street 1:2675 36TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8024
Practice Address - Country:US
Practice Address - Phone:304-485-7447
Practice Address - Fax:304-485-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV56314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003905000Medicaid
WV515047Medicare ID - Type Unspecified
WV0003905000Medicaid