Healthcare Provider Details

I. General information

NPI: 1740365394
Provider Name (Legal Business Name): MARY WASHINGTON CONVALESCENT & NURSING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MCKINNEY BLVD
COLONIAL BEACH VA
22443-1237
US

IV. Provider business mailing address

12093 GAYTON RD
RICHMOND VA
23238-3401
US

V. Phone/Fax

Practice location:
  • Phone: 804-224-2222
  • Fax: 804-224-2282
Mailing address:
  • Phone: 804-521-0550
  • Fax: 804-521-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2627
License Number StateVA

VIII. Authorized Official

Name: MR. GRAHAM L ADELMAN
Title or Position: PRESIDENT
Credential:
Phone: 804-521-0550