Provider Demographics
NPI:1437158904
Name:HOLBROOK NURSING HOME, INC.
Entity Type:Organization
Organization Name:HOLBROOK NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:LAINE
Authorized Official - Last Name:HITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-472-3280
Mailing Address - Street 1:346 S FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2452
Mailing Address - Country:US
Mailing Address - Phone:304-472-3280
Mailing Address - Fax:304-472-6805
Practice Address - Street 1:346 S FLORIDA ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2452
Practice Address - Country:US
Practice Address - Phone:304-472-3280
Practice Address - Fax:304-472-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003770000Medicaid
WV515076Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER