# FAYETTE NURSING & REHABILITATION CENTER LLC

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

## Provider details

- **NPI number:** 1871659730
- **Authorized official:** TODD JONES (EXECUTIVE VICE PRESIDENT)
- **Authorized official phone:** (304) 344-1623

## Contact information

- **Practice address:** 100 HRESAN BLVD, FAYETTEVILLE, WV 25840-1333
- **Practice address phone:** (304) 574-0770
- **Practice address fax:** (304) 574-1434
- **Mailing address:** 100 HRESAN BLVD, FAYETTEVILLE, WV 25840-1333
- **Mailing address phone:** (304) 574-0770
- **Mailing address fax:** (304) 574-1434

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 48 | WV | Yes |

## Other

- **Enumeration date:** 12/28/2006
- **Last updated:** 11/19/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0003077000 | — | WV |