| NPI | 1417956673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA L ROSENBAUGH Medical Billing Supervisor 757-716-2065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: VA NH2678) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: VA ERO 03-176) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2017-10-24 |