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Organization
1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC
Active
Organization
1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC
Active
Other names
Pierpont Center at Fairmont Campus
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T BERG (SECRETARY)
(610) 444-6350
Entity
Organization
Contact information
Practice address
1543 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
(304) 363-2273
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 347-4099
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
59
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810013993
—
WV
Enumeration date
12/30/2008
Last updated
07/09/2025
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