Organization
RSCR WEST VIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGIE MATTINGLY (MGR PROVIDER ENROLLMENT)
(502) 630-7425
Entity
Organization
Contact information
Practice address
176 SANDFIELD ROAD, WARDENSVILLE, WV 26851
(304) 260-8820
Mailing address
805 N WHITTINGTON PKWY, LOUISVILLE, KY 40222-7101
(800) 866-0860
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054503500
—
DC
Enumeration date
09/15/2010
Last updated
08/12/2021
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