Organization
RSCR WEST VIRGINIA, INC
Active
Other names
Potomac
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEENA G. OMBRES (ASSOC. GEN. COUNSEL/PRIVACY OFFICER)
(502) 394-2387
Entity
Organization
Contact information
Practice address
26 DAVIS ST, PETERSBURG, WV 26847-1535
(304) 257-4474
(304) 257-1936
Mailing address
9901 LINN STATION RD, LOUISVILLE, KY 40223-3808
(800) 866-0860
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
383
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0003322000
—
WV
Enumeration date
12/20/2006
Last updated
11/22/2011
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