Organization
RSCR WEST VIRGINIA, INC.
Active
Other names
Tygart Drive Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE MATTINGLY (MANAGER-PROVIDER ENROLLMENT)
(502) 381-3579
Entity
Organization
Contact information
Practice address
203 TYGART DRIVE, PHILLIPPI, WV 26416
(304) 472-4227
Mailing address
805 N WHITTINGTON PKWY, LOUISVILLE, KY 40222-7101
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
11/09/2020
Last updated
11/09/2020
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