1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC (NPI# 1942446745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942446745 |
| Entity Type | Organization |
| Organization Name | 1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC |
| Other Organization Name | WISHING WELL ASSISTED LIVING COMMUNITY AT FAIRMONT CAMPUS |
| Practice Address |
1543 Country Club Rd Fairmont WV 26554-1306 |
| Mailing Address |
101 E State St Kennett Square PA 19348-3109 |
| Practice Telephone | 3043632273 |
| Mailing Telephone | 6109254436 |
| Mailing Fax Number | 6103474099 |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2011-11-16 |
| Authorized Official Name | JANE DROPESKEY (CORPORATE MANAGER) |
| Authorized Official Telephone | 6109254231 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 506062 | WV | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Wishing Well Assisted Living Community at Fairmont Campus | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396981064 | 1543 Country Club Road Manor Operations LLC | Skilled Nursing Facility | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2008-12-30 |
| Street Address |
1543 COUNTRY CLUB RD |
| City | FAIRMONT |
| State | WV |
| Zip Code | 26554-1306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073501466 | Wishing Well Manor, Inc. | Skilled Nursing Facility | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2005-10-10 |
| 1700486008 | Randi Dawnielle Davis | Nurse Practitioner | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2020-10-27 |
| 1083277222 | Breanna Marie Kalanish | Occupational Therapy Assistant | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2019-04-14 |
| 1124597935 | Kira Leigh Nixon | Occupational Therapy Assistant | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2018-11-21 |
| 1659860328 | Lara Nicole Angelilli | Speech-Language Pathologist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2018-05-08 |
| 1487181095 | Debbie Stahl | Physical Therapy Assistant | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2017-05-12 |
| 1609270586 | Trinity Celapino | Physical Therapy Assistant | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2014-10-21 |
| 1649588948 | Ashley Nicole Kallop | Speech-Language Pathologist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2010-09-21 |
| 1699081265 | Erica Nicole Mouser | Occupational Therapist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2010-08-20 |
| 1447565973 | Samantha Jo Stickley | Physical Therapist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2010-08-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497680 | Vanquisha Clay | Technician | 118 Conaway St, Fairmont, WV 26554 | 2020-11-06 |
| 1851903363 | Denise S Greer | Technician | 1029 Prickett Road, Fairmont, WV 26554 | 2020-08-18 |
| 1730790775 | Darla Lee Mcrobie | Technician | 105 C'anna Square, Fairmont, WV 26554 | 2020-08-13 |
| 1376025718 | Jason Batten | Counselor | 621 Maryland Ave, Fairmont, WV 26554 | 2018-09-02 |
| 1437669066 | Ultimate Health & Wellness, LLC | Naturopath | 2862 Whitehall Blvd, Whitehall, WV 26554 | 2017-10-10 |
| 1457872376 | Michele R Lilley | Nurse Practitioner | 177 Middletown Rd, Ste1, Upc Whitehall Medical, Fairmont, WV 26554 | 2017-06-30 |
| 1477906154 | Rebecca Hayes-merrill | Counselor | 212 Adams St., 3rd Floor, Fairmont, WV 26554 | 2016-07-19 |
| 1790173417 | Dennis Michael Lynch | Counselor | 5 Turf Lane, Fairmont, WV 26554 | 2015-01-05 |
| 1336558725 | Nicole Savage | Home Health Aide | 122 Abbott St, Fairmont, WV 26554 | 2014-08-11 |
| 1124434550 | Achuta Ram Aynampudi | Psychiatry & Neurology | 100 Stoney Hill Rd, Fairmont, WV 26554 | 2014-07-07 |
| Find all providers in zip 26554 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801960083 | Greenbrier Ltc Inc | Assisted Living Facility | 703 South Walnut St, Fairmont, NC 28340 | 2006-11-20 |
| 1245215342 | City of Fairmont Nebraska - Fairview Manor Dba Country Reflections | Assisted Living Facility | 255 F St, Fairmont, NE 68354-9771 | 2005-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265049175 | Devonshire Al Operations, LLC | Assisted Living Facility | 5 Bexley Dr, Scott Depot, WV 25560-4504 | 2020-09-24 |
| 1073099073 | Greenwich Investors Cedar Grove Operator LLC | Assisted Living Facility | 110 Nicolette Rd, Parkersburg, WV 26104-7241 | 2018-07-13 |
| 1225526650 | Jonathan and Blessing LLC | Assisted Living Facility | 5312 Morning Dove Ln, Charleston, WV 25313-1154 | 2018-05-01 |
| 1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
| 1396155487 | Jay Wyn LLC | Assisted Living Facility | 608 North 10th Street, Weirton, WV 26062 | 2014-04-29 |
| 1689084790 | Jay Wyn L.l.c | Assisted Living Facility | 610 North 10th Street, Weirton, WV 26062 | 2014-04-29 |
| 1801211701 | Genesis | Assisted Living Facility | 934 S Fayette St, Beckley, WV 25801-6549 | 2014-02-28 |
| 1538427075 | Windy Hill Village | Assisted Living Facility | 17024 Veterans Memorial Hwy, Kingwood, WV 26537-8013 | 2012-05-02 |
| 1790069656 | Grayson Assisted Living Facility | Assisted Living Facility | 25 Old Trl, 3455 St Rt 75, Huntington, WV 25704-9281 | 2011-10-10 |
| 1164620902 | Braley Care Homes Inc | Assisted Living Facility | 2619 Knox Ave, Saint Albans, WV 25177-2130 | 2007-07-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.