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NPI Code Detail

MEDICARE: CCP VIRGINIA SLEEPY HOLLOW, LLC

MEDICARE: CCP VIRGINIA SLEEPY HOLLOW, LLC
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
1314000000XSkilled Nursing FacilityVA

General Provider Information

NPI Number : 1174067961
Entity Type Code : Organization
Provider Name (Legal Business Name) : CCP VIRGINIA SLEEPY HOLLOW, LLC
Provider Business Mailing Address
First Line : 6700 COLUMBIA PIKE
Second Line :
City : ANNANDALE
State : VA
Zip : 22003-3450
Country : US
Telephone Number : 703-256-7000
Fax Number : 703-354-4919
Provider Business Practice Location Address
First Line : 6700 COLUMBIA PIKE
Second Line :
City : ANNANDALE
State : VA
Zip : 22003-3450
Country : US
Telephone Number : 703-256-7000
Fax Number : 703-354-4919
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : DAVID RUBENSTEIN
Credential :
Telephone Number : 404-786-8528
Provider Enumeration Date : 12/13/2016
Last Update Date : 12/13/2016

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Directions to “CCP VIRGINIA SLEEPY HOLLOW, LLC ” Practice Location

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