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STATE OF WEST VIRGINIA NPI 1619969706


NPI Information

NPI: 1619969706
Provider Name: STATE OF WEST VIRGINIA

Other Name: JACKIE WITHROW HOSPITAL

Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization
Address:
105 S EISENHOWER DR
BECKLEY, WV
ZIP 25801
Phone: (304) 256-6600
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STATE OF WEST VIRGINIA is a nursing facility intermediate care facility in Beckley, WV. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. STATE OF WEST VIRGINIA NPI is 1619969706. The provider is registered as an organization entity type.
The provider Other Name Is Jackie Withrow Hospital.

The provider's business location address is:

105 S EISENHOWER DR
BECKLEY, WV
ZIP 25801-929
Phone: (304) 256-6600
Fax: (304) 250-6554

The provider's authorized official is Carla Jean Parent .
The authorized official title is Chief Financial Officer and has the following contact phone number (304) 256-6600.

The enumeration date for this NPI number is 8/16/2005 and was last updated on 2/5/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1313M00000XNursing Facility/Intermediate Care Facility181WEST VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10003978000MEDICAIDWEST VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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