# WVUPC QUARRY MANOR

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WVU Physicians of Charleston
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942507595
- **Authorized official:** TERRY MILLER (PROVIDER RELATIONS ANALYST)
- **Authorized official phone:** (304) 293-5033

## Contact information

- **Practice address:** 699 S PARK RD, CHARLESTON, WV 25304-2627
- **Practice address phone:** (304) 347-1296
- **Practice address fax:** (304) 347-1394
- **Mailing address:** PO BOX 7000, MORGANTOWN, WV 26507-7000
- **Mailing address phone:** (304) 293-7401

## Taxonomy

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

## Other

- **Enumeration date:** 02/17/2011
- **Last updated:** 02/17/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4002106000 | — | WV |