Provider Demographics
NPI:1518023456
Name:MCDOWELL NURSING & REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:MCDOWELL NURSING & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-344-1623
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:WV
Mailing Address - Zip Code:24836-0220
Mailing Address - Country:US
Mailing Address - Phone:304-448-2121
Mailing Address - Fax:304-448-3355
Practice Address - Street 1:ROUTE 103
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:WV
Practice Address - Zip Code:24836-0220
Practice Address - Country:US
Practice Address - Phone:304-448-2121
Practice Address - Fax:304-448-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0002794000Medicaid
WV515162Medicare ID - Type UnspecifiedMEDICARE NUMBER