# MONONGALIA HOME CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Sundale Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790865962
- **Authorized official:** MR. MICHAEL WAYNE HICKS N.H.A. (MANAGING AGENT)
- **Authorized official phone:** (304) 599-0497

## Contact information

- **Practice address:** 800 J D ANDERSON DR, MORGANTOWN, WV 26505-3474
- **Practice address phone:** (304) 599-0497
- **Practice address fax:** (304) 599-9083
- **Mailing address:** 800 J D ANDERSON DR, MORGANTOWN, WV 26505-3474
- **Mailing address phone:** (304) 599-0497
- **Mailing address fax:** (304) 599-9083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 23 | WV | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 03/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1790865962 | — | WV |