1543 Country Club Road Manor Operations LLC
NPI 1396981064ActiveOrganization· Skilled Nursing Facility· Fairmont, WV
Skilled Nursing Facility in Fairmont, West Virginia, registered in NPPES in December 2008. The authorized official on file is Michael T. Berg, Secretary. Enrolled in Medicare as part a provider - skilled nursing facility.
Overview
| NPI | 1396981064 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 30, 2008 |
| Last updated in NPPES | Jul 9, 2025 |
| Certified by provider | Jul 9, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Skilled Nursing Facility Primary | 314000000X | 59 | WV |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part A Provider - Skilled Nursing Facility (WV) |
|---|
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