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JACKIE WITHROW HOSPITAL
NPI 1619969706
Nursing Facility/Intermediate Care Facility in Beckley, WV

Active since August 16, 2005CLIA 51D0876916 · Waiver
105 S EISENHOWER DR, BECKLEY, WV 25801(304) 256-6600(304) 250-6554 Get Directions Write a Review

NPPES record last updated: February 5, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jackie Withrow Hospital NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKIE WITHROW HOSPITAL (NPI 1619969706) is a healthcare organization registered as a nursing facility/intermediate care facility in Beckley, West Virginia and active in the NPI registry since August 2005. The organization holds a CLIA Waiver certificate valid through September 26, 2027 and lists Carla Jean Parent, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1619969706
Entity TypeOrganization
Primary Taxonomy313M00000X
Legal Business NameSTATE OF WEST VIRGINIA
Location Address105 S EISENHOWER DRBeckley, WV 25801-4929
Mailing Address105 S Eisenhower DrBeckley, WV 25801-4929 · (304) 256-6600 · Fax (304) 250-6554
Phone(304) 256-6600
Fax(304) 250-6554
Organization SubpartNo
Authorized OfficialCarla Jean ParentChief Financial Officer · (304) 256-6600
Enumeration DateAugust 16, 2005
Last NPPES UpdateFebruary 5, 2010
✔ NPI 1619969706 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
Taxonomy Code313M00000X
License✔ Licensed in WV · 181
Definition

An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

105 S EISENHOWER DR, Beckley, WV 25801
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Other Names 1

Other NameJackie Withrow Hospital

Other Identifiers 1

Medicaid0003978000WV

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 51D0876916

Jackie Withrow Hospital · Beckley, WV
Active · expires Sep 26, 2027
CLIA Number51D0876916
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 27, 2025
Certificate Expiration DateSeptember 26, 2027
Laboratory DirectorMs. Donna Ortiz
Laboratory Phone(304) 256-6600
Laboratory LocationJackie Withrow Hospital105 S Eisenhower Drive, Beckley, WV 25801
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEALTH CARE ALLIANCE, INC.
Emergency Medicine
105 S EISENHOWER DR
BECKLEY, WV 25801
Raleigh County (304) 256-6600
MISS ERYKAH YVONNE STARKS LPN
Licensed Practical Nurse
105 S EISENHOWER DR
BECKLEY, WV 25801
Raleigh County (304) 256-6600
JACKIE WITHROW WVA FACILITY OPERATIONS LLC
Nursing Facility/Intermediate Care Facility
105 S EISENHOWER DR
BECKLEY, WV 25801
Raleigh County (304) 256-6600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is State Of West Virginia's NPI number?

The NPI number for State Of West Virginia is 1619969706. It was assigned to this organization in the NPPES registry on August 16, 2005. The provider is also known as Jackie Withrow Hospital.

Where is State Of West Virginia located?

State Of West Virginia is located at 105 S Eisenhower Dr, Beckley, WV 25801. The listed phone number is (304) 256-6600.

What is State Of West Virginia's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Does State Of West Virginia hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 51D0876916) is associated with this NPI, valid through September 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for State Of West Virginia was last updated on February 5, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.