Healthcare Provider Details

I. General information

NPI: 1396768644
Provider Name (Legal Business Name): VIDELL HEALTHCARE DUFFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 ROSS CARTER BLVD
DUFFIELD VA
24244-5116
US

IV. Provider business mailing address

157 ROSS CARTER BLVD
DUFFIELD VA
24244-0280
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-2841
  • Fax: 276-431-2345
Mailing address:
  • Phone: 276-431-2841
  • Fax: 276-431-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2664
License Number StateVA

VIII. Authorized Official

Name: MRS. KATHLEEN D MACE
Title or Position: EXEC VICE PRES
Credential: RN DCS
Phone: 253-277-3197