Provider Demographics
NPI:1366506941
Name:RSCR WEST VIRGINIA, INC.
Entity Type:Organization
Organization Name:RSCR WEST VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE GENERAL COUNSEL & PRIVACY
Authorized Official - Prefix:MS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:G
Authorized Official - Last Name:OMBRES
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:502-394-2387
Mailing Address - Street 1:9901 LINN STATION ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223
Mailing Address - Country:US
Mailing Address - Phone:502-394-2100
Mailing Address - Fax:502-394-2285
Practice Address - Street 1:RR 6 BOX 454
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-8839
Practice Address - Country:US
Practice Address - Phone:304-472-5503
Practice Address - Fax:304-472-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003179000Medicaid