Organization
RESCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANDI SHAFFER (EXECUTIVE DIRECTOR)
(304) 225-4550
Entity
Organization
Contact information
Practice address
1542 MARY LOU RETTON DR, FAIRMONT, WV 26554-2225
(304) 366-4415
Mailing address
5000 GREENBAG ROAD, UNIT B-6, MORGANTOWN, WV 26201
(304) 225-4550
(304) 225-4555
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
298
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005258026
—
WV
Enumeration date
12/27/2006
Last updated
08/22/2020
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