Healthcare Provider Details

I. General information

NPI: 1467260752
Provider Name (Legal Business Name): 906 THOMPSON STREET OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 THOMPSON ST
ASHLAND VA
23005-1128
US

IV. Provider business mailing address

906 THOMPSON ST
ASHLAND VA
23005-1128
US

V. Phone/Fax

Practice location:
  • Phone: 804-798-3291
  • 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: TIFFANY HOBACK
Title or Position: MANAGER
Credential:
Phone: 770-698-9040