# STATE OF WEST VIRGINIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackie Withrow Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619969706
- **Authorized official:** MS. CARLA JEAN PARENT (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (304) 256-6600

## Contact information

- **Practice address:** 105 S EISENHOWER DR, BECKLEY, WV 25801-4929
- **Practice address phone:** (304) 256-6600
- **Practice address fax:** (304) 250-6554
- **Mailing address:** 105 S EISENHOWER DR, BECKLEY, WV 25801-4929
- **Mailing address phone:** (304) 256-6600
- **Mailing address fax:** (304) 250-6554

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 181 | WV | Yes |

## Other

- **Enumeration date:** 08/16/2005
- **Last updated:** 02/05/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0003978000 | — | WV |