Organization
MONONGALIA HOME CORPORATION
Active
Other names
Sundale Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL WAYNE HICKS N.H.A. (MANAGING AGENT)
(304) 599-0497
Entity
Organization
Contact information
Practice address
800 J D ANDERSON DR, MORGANTOWN, WV 26505-3474
(304) 599-0497
(304) 599-9083
Mailing address
800 J D ANDERSON DR, MORGANTOWN, WV 26505-3474
(304) 599-0497
(304) 599-9083
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
23
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790865962
—
WV
Enumeration date
10/16/2006
Last updated
03/27/2023
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