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NPI Code Detail

MEDICARE: KING GEORGE LIFE CARE, LLC

MEDICARE: KING GEORGE LIFE CARE, 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 FacilityNH2577VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2180508OTHERANTHEM BCBS
3200515607OTHERFEDERAL BLACK LUNG

General Provider Information

NPI Number : 1417449422
Entity Type Code : Organization
Provider Name (Legal Business Name) : KING GEORGE LIFE CARE, LLC
Provider Business Mailing Address
First Line : 10051 FOXES WAY
Second Line :
City : KING GEORGE
State : VA
Zip : 22485-3458
Country : US
Telephone Number : 540-775-4000
Fax Number : 540-775-3637
Provider Business Practice Location Address
First Line : 10051 FOXES WAY
Second Line :
City : KING GEORGE
State : VA
Zip : 22485-3458
Country : US
Telephone Number : 540-775-4000
Fax Number : 540-775-3637
Authorized Official
Title or Position : COMPLIANCE & PRIVACY OFFICER
Name : CASSANDRA GALLANT
Credential :
Telephone Number : 540-774-4263
Provider Enumeration Date : 06/05/2018
Last Update Date : 11/25/2024

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Directions to “KING GEORGE LIFE CARE, LLC ” Practice Location

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