National Provider Identifier Database

1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC
Skilled Nursing Facility

(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.


Contact Information

1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC
1543 COUNTRY CLUB RD
FAIRMONT, WV26554-1306
Phone: 304-363-2273
Fax:
Website:
Specialty Taxonomy Code
* Skilled Nursing Facility 314000000X

* Indicates primary specialty

NPI Profile & details for 1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC

NPI Number 1396981064
Legal business name
LBN
1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC
Authorized official MICHAEL BERG - (SECRETARY)
Entity Organization
Organization subpart No
Enumeration date 12/30/2008
Last updated 07/09/2025 - About 11 months ago
Sole proprietor1 Not specified
Identifiers
  • WV License #: 59
  • WV Medicaid: 3810013993

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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