Provider Demographics
NPI:1053542555
Name:ARBORS OF FAIRMONT
Entity type:Organization
Organization Name:ARBORS OF FAIRMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:N
Authorized Official - Last Name:COFFINDAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-476-8053
Mailing Address - Street 1:1700 BIG TREE DR APT 79
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8310
Mailing Address - Country:US
Mailing Address - Phone:304-476-8053
Mailing Address - Fax:
Practice Address - Street 1:1700 BIG TREE DR APT 79
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8310
Practice Address - Country:US
Practice Address - Phone:304-476-8053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1393314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility