# BROADDUS HOSPITAL ASSOCIATION, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mansfield Place
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215097613
- **Authorized official:** MRS. DANA L. GOULD (CEO)
- **Authorized official phone:** (304) 457-1760

## Contact information

- **Practice address:** \#5 HEALTHCARE DRIVE, MANSFIELD HILL, PHILIPPI, WV 26416
- **Practice address phone:** (304) 457-8535
- **Practice address fax:** (304) 457-1516
- **Mailing address:** \#5 HEALTHCARE DRIVE, P.O. BOX 930, PHILIPPI, WV 26416
- **Mailing address phone:** (304) 457-8535
- **Mailing address fax:** (304) 457-1516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 96 | WV | Yes |

## Other

- **Enumeration date:** 12/08/2006
- **Last updated:** 07/09/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0002167001 | — | WV |