Kaufman Street WV LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

KAUFMAN STREET WV LLC

Doing business as

Arbors at Fairmont

Practice address

130 Kaufman Dr
Fairmont, WV 26554-2179

Phone

(304) 363-5633

NPI assigned

Jul 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Donna J Maassen

Title

Privacy Officer

Phone

(414) 908-8119

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Arbors at Fairmont Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1346274370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W MICHIGAN ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532032903",
            "telephone_number": "414-908-8119",
            "fax_number": "414-908-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 KAUFMAN DR",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265542179",
            "telephone_number": "304-363-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAUFMAN STREET WV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "MAASSEN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRIVACY OFFICER",
        "authorized_official_telephone_number": "414-908-8119",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0004212000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arbors at Fairmont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jesalyn Kamaka, BS
• Maliha Kamal, MD
• Hebah Kassar, DDS
• Sitharama Swamy Katragadda, MD
• Sudha Rani Katragadda, MD
• Addison Kaufmann
• Gloria Daemi Kayfan, DO
• Jeana Susan Keener
• Jeniece Marie Kegley
• Milly Mae Kellar

• Skilled Nursing Facility in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Skilled Nursing Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.