Provider Demographics
NPI:1912993171
Name:WV DEPT. OF HEALTH & HEALTH FACILITIES
Entity Type:Organization
Organization Name:WV DEPT. OF HEALTH & HEALTH FACILITIES
Other - Org Name:HOPEMONT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAYBECK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, LCSW
Authorized Official - Phone:304-789-2411
Mailing Address - Street 1:RR 3 BOX 330
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-9710
Mailing Address - Country:US
Mailing Address - Phone:304-789-2411
Mailing Address - Fax:304-789-2233
Practice Address - Street 1:RR 3 BOX 330
Practice Address - Street 2:
Practice Address - City:TERRA ALTA
Practice Address - State:WV
Practice Address - Zip Code:26764-9710
Practice Address - Country:US
Practice Address - Phone:304-789-2411
Practice Address - Fax:304-789-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51E148313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV51E148Medicaid