# 1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pierpont Center at Fairmont Campus
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396981064
- **Authorized official:** MICHAEL T BERG (SECRETARY)
- **Authorized official phone:** (610) 444-6350

## Contact information

- **Practice address:** 1543 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
- **Practice address phone:** (304) 363-2273
- **Mailing address:** 101 E STATE ST, KENNETT SQUARE, PA 19348-3109
- **Mailing address phone:** (610) 925-4436
- **Mailing address fax:** (610) 347-4099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 59 | WV | Yes |

## Other

- **Enumeration date:** 12/30/2008
- **Last updated:** 07/09/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3810013993 | — | WV |