Organization
STONEBROOK, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN W FANNING (EXECUTIVE DIRECTOR)
(304) 267-2763
Entity
Organization
Contact information
Practice address
3273 CHARLES TOWN RD, KEARNEYSVILLE, WV 25430-2649
(304) 267-2763
(304) 267-1514
Mailing address
PO BOX 70, KEARNEYSVILLE, WV 25430-0070
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
36
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005330000
—
WV
Enumeration date
04/18/2007
Last updated
08/22/2020
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