Provider Demographics
NPI:1841465473
Name:ELKINS REGIONAL CONVALESCENT CENTER
Entity type:Organization
Organization Name:ELKINS REGIONAL CONVALESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-1391
Mailing Address - Street 1:1175 BEVERLY PIKE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-9759
Mailing Address - Country:US
Mailing Address - Phone:304-636-1391
Mailing Address - Fax:304-636-1371
Practice Address - Street 1:1175 BEVERLY PIKE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9759
Practice Address - Country:US
Practice Address - Phone:304-636-1391
Practice Address - Fax:304-636-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV134343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0146591000Medicaid