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Organization
MONONGALIA HOME CORPORATION
Active
Organization
MONONGALIA HOME CORPORATION
Active
Other names
Sundale Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL WAYNE HICKS N.H.A. (MANAGING AGENT)
(304) 599-0497
Entity
Organization
Contact information
Practice address
800 J D ANDERSON DR, MORGANTOWN, WV 26505-3474
(304) 599-0497
(304) 599-9083
Mailing address
800 J D ANDERSON DR, MORGANTOWN, WV 26505-3474
(304) 599-0497
(304) 599-9083
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
23
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790865962
—
WV
Enumeration date
10/16/2006
Last updated
03/27/2023
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