Provider Demographics
NPI:1215818711
Name:MANCHIN WVA FACILITY OPERATIONS LLC
Entity type:Organization
Organization Name:MANCHIN WVA FACILITY OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-340-2707
Mailing Address - Street 1:401 GUFFEY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4029
Mailing Address - Country:US
Mailing Address - Phone:304-363-2500
Mailing Address - Fax:
Practice Address - Street 1:401 GUFFEY ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4029
Practice Address - Country:US
Practice Address - Phone:304-363-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility