Provider Demographics
NPI:1558367292
Name:ELKINS REGIONAL CONVALESCENT CENTER
Entity Type:Organization
Organization Name:ELKINS REGIONAL CONVALESCENT CENTER
Other - Org Name:ELKINS REHABILITATION & CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-1391
Mailing Address - Street 1:2533 BEVERLY PIKE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-9401
Mailing Address - Country:US
Mailing Address - Phone:304-636-1391
Mailing Address - Fax:304-636-1371
Practice Address - Street 1:2533 BEVERLY PIKE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9401
Practice Address - Country:US
Practice Address - Phone:304-636-1391
Practice Address - Fax:304-636-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV134313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003315000Medicaid
WV0146591000Medicaid
WV515025Medicare ID - Type Unspecified