Provider Demographics
NPI:1245495506
Name:WEIRTON GERIATRIC CENTER, INC.(NEMS)
Entity type:Organization
Organization Name:WEIRTON GERIATRIC CENTER, INC.(NEMS)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUATTROCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-723-4300
Mailing Address - Street 1:2525 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3634
Mailing Address - Country:US
Mailing Address - Phone:304-723-4300
Mailing Address - Fax:304-723-1532
Practice Address - Street 1:2525 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3634
Practice Address - Country:US
Practice Address - Phone:304-723-4300
Practice Address - Fax:304-723-1532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEIRTON GERIATRIC CENTER, INC.(SNF)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003965002Medicaid