Provider Demographics
NPI:1518021625
Name:RESCARE WEST VIRGINIA, INCORPORATED
Entity Type:Organization
Organization Name:RESCARE WEST VIRGINIA, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-326-0140
Mailing Address - Street 1:1618 BUCKHANNON PIKE
Mailing Address - Street 2:
Mailing Address - City:NUTTER FORT
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4465
Mailing Address - Country:US
Mailing Address - Phone:304-326-0140
Mailing Address - Fax:304-326-0152
Practice Address - Street 1:272 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-1223
Practice Address - Country:US
Practice Address - Phone:304-782-3068
Practice Address - Fax:304-782-3068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV335315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities