1543 Country Club Road Manor Operations LLC
NPI 1942446745ActiveOrganization· Assisted Living Facility· Fairmont, WV
Assisted Living Facility in Fairmont, West Virginia, registered in NPPES in December 2008. The authorized official on file is Michael T. Berg, Secretary.
Overview
| NPI | 1942446745 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 29, 2008 |
| Last updated in NPPES | Jul 9, 2025 |
| Certified by provider | Jul 9, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Assisted Living Facility Primary | 310400000X | 506062 | WV |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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