Provider Demographics
NPI:1366528952
Name:RUSSELL NESBITT SERVICES, INC.
Entity type:Organization
Organization Name:RUSSELL NESBITT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRILYN
Authorized Official - Middle Name:FARKAS
Authorized Official - Last Name:VANTASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:304-232-0233
Mailing Address - Street 1:431 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6529
Mailing Address - Country:US
Mailing Address - Phone:304-232-0233
Mailing Address - Fax:304-232-1819
Practice Address - Street 1:431 FULTON ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6529
Practice Address - Country:US
Practice Address - Phone:304-232-0233
Practice Address - Fax:304-232-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV93251B00000X, 251C00000X, 251J00000X, 320600000X, 320900000X, 347C00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251J00000XAgenciesNursing Care
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005252002Medicaid
WV0005452003Medicaid
WV0005452001Medicaid