Provider Demographics
NPI:1205388295
Name:MORGANTOWN SNF ACQUISITION LLC
Entity Type:Organization
Organization Name:MORGANTOWN SNF ACQUISITION LLC
Other - Org Name:MAPLESHIRE OUTPATIENT THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-343-1950
Mailing Address - Street 1:7500 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2935
Mailing Address - Country:US
Mailing Address - Phone:304-343-1950
Mailing Address - Fax:304-343-1947
Practice Address - Street 1:30 MON GENERAL DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2853
Practice Address - Country:US
Practice Address - Phone:304-285-2720
Practice Address - Fax:304-285-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy