Healthcare Provider Details

I. General information

NPI: 1639753809
Provider Name (Legal Business Name): APPOMATTOX CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 EVERGREEN AVE
APPOMATTOX VA
24522-4501
US

IV. Provider business mailing address

235 EVERGREEN AVE
APPOMATTOX VA
24522-4501
US

V. Phone/Fax

Practice location:
  • Phone: 434-352-7420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 434-352-7420