MEDICARE: WILLIAMSBURG LANDING INC.

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
1	314000000X	Skilled Nursing Facility	NH2729	VA
2	310400000X	Assisted Living Facility	PLO040016	VA

General Provider Information

NPI Number	:	1427054410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSBURG LANDING INC.

Provider Business Mailing Address
First Line	:	5700 WILLIAMSBURG LANDING DR
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3779
Country	:	US
Telephone Number	:	757-253-0303
Fax Number	:	757-565-6537

Provider Business Practice Location Address
First Line	:	5500 WILLIAMSBURG LANDING DR
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-8064
Country	:	US
Telephone Number	:	757-253-0303
Fax Number	:	757-565-6537

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	NANCY HARRISON
Credential	:
Telephone Number	:	757-253-0303

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	08/22/2020

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