Provider Demographics
NPI:1649336561
Name:MERCER NURSING & REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:MERCER NURSING & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-344-1623
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:ROGERS & PEARIS STREET
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-0410
Mailing Address - Country:US
Mailing Address - Phone:304-325-5448
Mailing Address - Fax:304-327-7660
Practice Address - Street 1:ROGERS AND PEARIS STREETS
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-0410
Practice Address - Country:US
Practice Address - Phone:304-325-5448
Practice Address - Fax:304-327-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0004250000Medicaid
WV515052Medicare ID - Type UnspecifiedMEDICARE NUMBER