NPIMap

Organization Active NPI

State of West Virginia

  • Nursing Facility/Intermediate Care Facility
  • Beckley, WV
National Provider Identifier
1619969706
Registry record updated Feb 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
181 Issued in WV
Legal business name
STATE OF WEST VIRGINIA
Practice address
105 S Eisenhower Dr
Beckley, WV 25801-4929
Phone
(304) 256-6600
Fax
(304) 250-6554
NPI assigned
Aug 16, 2005
Last updated
Feb 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2010

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

Authorized official

Name
Ms. Carla Jean Parent
Title
Chief Financial Officer
Phone
(304) 256-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 181 WV Primary

Addresses

Primary practice location

105 S Eisenhower Dr
Beckley, WV 25801-4929

Mailing address

105 S Eisenhower Dr
Beckley, WV 25801-4929
Phone (304) 256-6600

Other identifiers 1

IdentifierTypeStateIssuer
0003978000MedicaidWV

Other names 1

  • Jackie Withrow Hospital Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265328000000",
    "number": "1619969706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S EISENHOWER DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258014929",
            "telephone_number": "304-256-6600",
            "fax_number": "304-250-6554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S EISENHOWER DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258014929",
            "telephone_number": "304-256-6600",
            "fax_number": "304-250-6554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF WEST VIRGINIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2010-02-05",
        "status": "A",
        "authorized_official_last_name": "PARENT",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "304-256-6600",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WV",
            "license": "181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003978000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackie Withrow Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beckley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; 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.