Provider Demographics
NPI:1740270982
Name:GRANT REHAB & CARE CENTER
Entity type:Organization
Organization Name:GRANT REHAB & CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-257-4233
Mailing Address - Street 1:127 EARLY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-9403
Mailing Address - Country:US
Mailing Address - Phone:304-257-4233
Mailing Address - Fax:304-257-4610
Practice Address - Street 1:127 EARLY AVENUE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9403
Practice Address - Country:US
Practice Address - Phone:304-257-4233
Practice Address - Fax:304-257-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1065000OtherWORKER'S COMPENSATION
WV0004108000Medicaid
WV1065000OtherWORKER'S COMPENSATION