# MOUNTAIN STATE HOME REHAB, INC,

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

## Provider details

- **NPI number:** 1558311266
- **Authorized official:** MARY JANE BANIAK PT (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (304) 726-4212

## Contact information

- **Practice address:** RR 5 BOX 521, KEYSER, WV 26726-9016
- **Practice address phone:** (304) 726-4212
- **Practice address fax:** (304) 726-4213
- **Mailing address:** RR 5 BOX 521, KEYSER, WV 26726-9016
- **Mailing address phone:** (304) 726-4212
- **Mailing address fax:** (304) 726-4213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 1589 | WV | Yes |
| 251E00000X | Home Health Agency | 21695 | MD | — |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 08/22/2020