MEDICARE: VIRGINIA BEACH LIFE CARE CORP

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	NH2582	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	608693000	OTHER	VA	FEDERAL BLACK LUNG ID
2	227271	OTHER	VA	ANTHEM BCBS PPO HMO ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437149960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA BEACH LIFE CARE CORP

Provider Business Mailing Address
First Line	:	3131 ELECTRIC RD STE 100
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-6427
Country	:	US
Telephone Number	:	540-774-4263
Fax Number	:	540-774-0780

Provider Business Practice Location Address
First Line	:	5580 DANIEL SMITH RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1104
Country	:	US
Telephone Number	:	757-499-7029
Fax Number	:	757-499-1266

Authorized Official
Title or Position	:	CCO AND GENERAL COUNSEL
Name	:	JAMES HAINES
Credential	:
Telephone Number	:	540-774-4263

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	04/01/2019

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