1543 Country Club Road Manor Operations LLC
NPI #1942446745 in Fairmont, West Virginia
Provider Information
- NPI Number
- 1942446745
- Entity Type
- Organization
- Organization Name
- 1543 Country Club Road Manor Operations LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Dec 29, 2008
- Last Updated
- Jul 9, 2025
Practice Location
- Address
- 1543 COUNTRY CLUB RD
- City
- Fairmont
- State
- West Virginia
- ZIP Code
- 26554-1306
- Phone
- (304) 363-2273
Authorized Official
- Name
- MICHAEL T BERG
- Title
- SECRETARY
- Phone
- (610) 444-6350
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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