Provider Demographics
NPI:1780682088
Name:NELLA'S NURSING HOME, INC
Entity Type:Organization
Organization Name:NELLA'S NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHASTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-2033
Mailing Address - Street 1:PO BOX 1399
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1399
Mailing Address - Country:US
Mailing Address - Phone:304-636-2033
Mailing Address - Fax:304-637-6206
Practice Address - Street 1:200 WHITEMAN AVE
Practice Address - Street 2:CRYSTAL SPRINGS
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3400
Practice Address - Country:US
Practice Address - Phone:304-636-2033
Practice Address - Fax:304-637-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility