Provider Demographics
NPI:1902802259
Name:MOUND VIEW HEALTH CARE, INC.
Entity Type:Organization
Organization Name:MOUND VIEW HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLGOVSKIJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-843-1035
Mailing Address - Street 1:2200 FLORAL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:304-843-1504
Practice Address - Street 1:2200 FLORAL ST
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1293
Practice Address - Country:US
Practice Address - Phone:304-843-1035
Practice Address - Fax:304-843-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV75314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003791000Medicaid
WV0003791000Medicaid