Organization
INDUSTRIAL REHABILITATION CENTER
Active
Organization
INDUSTRIAL REHABILITATION CENTER
Active
Other names
Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKI L. RUSSELL-MASH (ADMINISTRATOR)
(740) 446-5551
Entity
Organization
Contact information
Practice address
313 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25303-1263
(304) 744-2300
(304) 744-8195
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5387
(740) 446-5982
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036280001
MEDICARE DMERC
WV
05
—
2219576
—
WV
Enumeration date
05/15/2006
Last updated
07/16/2009
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