Provider Demographics
NPI:1922404649
Name:WVDHHR JOHN MANCHIN SR. HEALTH CARE CENTER
Entity Type:Organization
Organization Name:WVDHHR JOHN MANCHIN SR. HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA CEO
Authorized Official - Phone:304-363-2500
Mailing Address - Street 1:401 GUFFEY STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-6554
Mailing Address - Country:US
Mailing Address - Phone:304-363-2500
Mailing Address - Fax:304-363-0263
Practice Address - Street 1:401 GUFFEY STREET
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-6554
Practice Address - Country:US
Practice Address - Phone:304-363-2500
Practice Address - Fax:304-363-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0004092000Medicaid
WV0004092000Medicaid