Healthcare Provider Details

I. General information

NPI: 1003849209
Provider Name (Legal Business Name): AMELIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 VIRGINIA ST
AMELIA COURT HOUSE VA
23002-4826
US

IV. Provider business mailing address

8830 VIRGINIA ST
AMELIA COURT HOUSE VA
23002-4826
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-5611
  • Fax: 804-561-5533
Mailing address:
  • Phone: 804-561-5611
  • Fax: 804-561-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2476
License Number StateVA

VIII. Authorized Official

Name: MRS. VIRGINIA SNEAD
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-561-5611