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NPI Code Detail

MEDICARE: SENTARA LIFE CARE CORPORATION

MEDICARE: SENTARA LIFE CARE CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care FacilityNH2730VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093706863
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENTARA LIFE CARE CORPORATION
Provider Business Mailing Address
First Line : 251 S NEWTOWN RD
Second Line :
City : NORFOLK
State : VA
Zip : 23502-5718
Country : US
Telephone Number : 757-892-5400
Fax Number : 757-892-5401
Provider Business Practice Location Address
First Line : 1604 OLD DONATION PKWY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-3063
Country : US
Telephone Number : 757-496-7100
Fax Number : 757-481-1589
Authorized Official
Title or Position : VICE PRESIDENT SENTARA LIFE CARE
Name : BRUCE ROBERTSON
Credential :
Telephone Number : 757-892-5400
Provider Enumeration Date : 11/02/2005
Last Update Date : 04/08/2008

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