Provider Demographics
NPI:1902913866
Name:MARDEN REHABILITATION ASSOCIATES OF PORTAGE COUNTY, INC.
Entity Type:Organization
Organization Name:MARDEN REHABILITATION ASSOCIATES OF PORTAGE COUNTY, INC.
Other - Org Name:MARDEN REHABILITATION ASSOCIATES OF WEST VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF CORPORATE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-373-9446
Mailing Address - Street 1:CORNER HARDING & RT 10 COOK PARKWAY
Mailing Address - Street 2:PO BOX 1930
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-1930
Mailing Address - Country:US
Mailing Address - Phone:304-682-7100
Mailing Address - Fax:304-682-7400
Practice Address - Street 1:832 COOK PARKWAY
Practice Address - Street 2:
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870-1930
Practice Address - Country:US
Practice Address - Phone:304-682-7100
Practice Address - Fax:304-682-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0203236000Medicaid
WV0203236000Medicaid