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Contact Information

80 MADDEX DRIVE OPERATIONS LLC
80 MADDEX DR
SHEPHERDSTOWN, WV25443-4305
 Phone: 304-876-9422
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
Indicates primary specialty

NPI Profile & details for 80 MADDEX DRIVE OPERATIONS LLC

NPI # 1144404443
LBN Legal business name 80 MADDEX DRIVE OPERATIONS LLC
Authorized official MICHAEL BERG - (SECRETARY)
Entity Organization
Organization subpart 1 No
Enumeration date 12/21/2007
Last updated 06/23/2025 - About 12 months ago
Identifiers
WV License # 133
WV Medicaid 0003509000
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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