Provider Demographics
NPI:1386709939
Name:RESCARE WEST VIRGINIA, INC.
Entity type:Organization
Organization Name:RESCARE WEST VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-858-2572
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:251 GORE RD
Mailing Address - City:GORE
Mailing Address - State:VA
Mailing Address - Zip Code:22637-0130
Mailing Address - Country:US
Mailing Address - Phone:540-858-2572
Mailing Address - Fax:540-858-2575
Practice Address - Street 1:1207 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1643
Practice Address - Country:US
Practice Address - Phone:304-263-4871
Practice Address - Fax:304-263-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV337315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003445001Medicaid