# MEADOWVIEW MANOR HEALTH CARE CENTER INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164421756
- **Authorized official:** MRS. TRACI L HENDERSON (CEO/ OWNER)
- **Authorized official phone:** (304) 842-7101

## Contact information

- **Practice address:** 41 CRESTVIEW TER, BRIDGEPORT, WV 26330-1010
- **Practice address phone:** (304) 842-7101
- **Practice address fax:** (304) 842-7104
- **Mailing address:** 41 CRESTVIEW TER, BRIDGEPORT, WV 26330-1010
- **Mailing address phone:** (304) 842-7101
- **Mailing address fax:** (304) 842-7104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 104 | WV | Yes |

## Other

- **Enumeration date:** 07/18/2005
- **Last updated:** 11/04/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0004114000 | — | WV |