Stonebrook, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

36 Issued in WV

Legal business name

STONEBROOK, INC

Practice address

3273 Charles Town Rd
Kearneysville, WV 25430-2649

Phone

(304) 267-2763

Fax

(304) 267-1514

NPI assigned

Apr 18, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John W Fanning

Title

Executive Director

Phone

(304) 267-2763

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609092477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "KEARNEYSVILLE",
            "state": "WV",
            "postal_code": "254300070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3273 CHARLES TOWN RD",
            "city": "KEARNEYSVILLE",
            "state": "WV",
            "postal_code": "254302649",
            "telephone_number": "304-267-2763",
            "fax_number": "304-267-1514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEBROOK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FANNING",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-267-2763"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WV",
            "license": "36",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005330000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Renee Smith
• Marley Smith
• Pamela Marie Smith
• Alfred Starlings IV, DPT
• Danielle Stateler, MSW
• Melissa Swartz, LPC
• Tequila Thurston
• Caroline L Trenary, LGSW
• Peggy Turner
• United Hospital Center, Inc.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Kearneysville, WV
• Providers in Kearneysville, WV by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.