# MINGO CARE CENTER, INC.

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

## Provider details

- **NPI number:** 1730177130
- **Authorized official:** MR. THOMAS SPHATT (CHIEF OF OPERATIONS & FINANCE)
- **Authorized official phone:** (304) 752-8761

## Contact information

- **Practice address:** 100 HILLCREST DR, WILLIAMSON, WV 25661-3948
- **Practice address phone:** (304) 235-7005
- **Practice address fax:** (304) 752-8768
- **Mailing address:** 100 HILLCREST DR, WILLIAMSON, WV 25661-3948
- **Mailing address phone:** (304) 235-7005
- **Mailing address fax:** (304) 752-8768

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 92 | WV | Yes |

## Other

- **Enumeration date:** 10/10/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0003991000 | — | WV |