1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC

Skilled Nursing Facility

OIG CLEARNPI VERIFIED

Location

FAIRMONT, WV

Licensed since

2008

Rate

—

Federal identifiers

NPI registry number1396981064

Agency details

Medicare activity

StatusNo Medicare utilization on file — neutral.

Authorized official

NameMICHAEL BERG

TitleSECRETARY

Phone3043632273

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Source: NPI Registry · Last refreshed June 24, 2026