# STONEBROOK, INC

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

## Provider details

- **NPI number:** 1609092477
- **Authorized official:** JOHN W FANNING (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (304) 267-2763

## Contact information

- **Practice address:** 3273 CHARLES TOWN RD, KEARNEYSVILLE, WV 25430-2649
- **Practice address phone:** (304) 267-2763
- **Practice address fax:** (304) 267-1514
- **Mailing address:** PO BOX 70, KEARNEYSVILLE, WV 25430-0070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 36 | WV | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0005330000 | — | WV |