Provider Demographics
NPI:1598766867
Name:FOX NURSING HOME, INC
Entity Type:Organization
Organization Name:FOX NURSING HOME, INC
Other - Org Name:THE STONE PEAR PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-387-0101
Mailing Address - Street 1:125 FOX LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:WV
Mailing Address - Zip Code:26034-1601
Mailing Address - Country:US
Mailing Address - Phone:304-387-0101
Mailing Address - Fax:304-387-1522
Practice Address - Street 1:125 FOX LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:WV
Practice Address - Zip Code:26034-1601
Practice Address - Country:US
Practice Address - Phone:304-387-0101
Practice Address - Fax:304-387-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003458000Medicaid
WV0003458000Medicaid