Healthcare Provider Details

I. General information

NPI: 1326582198
Provider Name (Legal Business Name): GL VIRGINIA ALLEGHANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 MAIN ST
CLIFTON FORGE VA
24422-1905
US

IV. Provider business mailing address

1725 MAIN ST
CLIFTON FORGE VA
24422-1905
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-5791
  • Fax: 540-862-4178
Mailing address:
  • Phone: 540-862-5791
  • Fax: 540-862-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID RUBENSTEIN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 404-786-8528