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Organization
1539 COUNTRY CLUB ROAD OPERATIONS LLC
Active
Organization
1539 COUNTRY CLUB ROAD OPERATIONS LLC
Active
Other names
Tygart Center at Fairmount Campus
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BERG (SECRETARY)
(610) 444-6350
Entity
Organization
Contact information
Practice address
1539 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
(304) 366-9100
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 612-5327
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
62
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810013992
—
WV
Enumeration date
12/30/2008
Last updated
06/23/2025
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