OrganizationActive
1539 Country Club Road Operations LLC
NPI 1578709341 · Skilled Nursing Facility · Fairmont, WV
Provider details
- NPI number
- 1578709341
- Entity type
- Organization
- Primary specialty
- Skilled Nursing FacilityNursing & Custodial Care Facilities
- Authorized official
- Michael Berg, Secretary
- License
- 62 (WV)
Mailing address
101 E State St
Kennett Square, PA 19348-3109
Registry dates
- Enumerated
- 2008-12-30
- Last updated
- 2025-06-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.