Healthcare Provider Details

I. General information

NPI: 1538977483
Provider Name (Legal Business Name): 237 FRANKLIN PIKE ROAD SE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 FRANKLIN PIKE SE
FLOYD VA
24091-2893
US

IV. Provider business mailing address

237 FRANKLIN PIKE SE
FLOYD VA
24091-2893
US

V. Phone/Fax

Practice location:
  • Phone: 540-745-2016
  • Fax: 540-745-4591
Mailing address:
  • Phone: 540-745-2016
  • Fax: 540-745-4591

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