Organization
BROADDUS HOSPITAL ASSOCIATION, INC.
Active
Other names
Mansfield Place
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANA L. GOULD (CEO)
(304) 457-1760
Entity
Organization
Contact information
Practice address
#5 HEALTHCARE DRIVE, MANSFIELD HILL, PHILIPPI, WV 26416
(304) 457-8535
(304) 457-1516
Mailing address
#5 HEALTHCARE DRIVE, P.O. BOX 930, PHILIPPI, WV 26416
(304) 457-8535
(304) 457-1516
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
96
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002167001
—
WV
Enumeration date
12/08/2006
Last updated
07/09/2019
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