# WVDHHR JOHN MANCHIN SR HEALTH CARE CENTER

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

## Provider details

- **NPI number:** 1417963000
- **Authorized official:** MS. CAROL D MERRILL NHA (CEO ADMINISTRATOR)
- **Authorized official phone:** (304) 363-2500

## Contact information

- **Practice address:** 401 GUFFEY STREET, FAIRMONT, WV 26554
- **Practice address phone:** (304) 363-2500
- **Practice address fax:** (304) 363-0263
- **Mailing address:** 401 GUFFEY STREET, FAIRMONT, WV 26554
- **Mailing address phone:** (304) 363-2500
- **Mailing address fax:** (304) 363-0263

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |

## Other

- **Enumeration date:** 08/01/2006
- **Last updated:** 12/04/2007