Healthcare Provider Details

I. General information

NPI: 1659466472
Provider Name (Legal Business Name): WARREN MEMORIAL HOSPITAL CENTER FOR HEALTHY AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 N SHENANDOAH AVE SUITE B
FRONT ROYAL VA
22630-3543
US

IV. Provider business mailing address

842 N SHENANDOAH AVE SUITE B
FRONT ROYAL VA
22630-3543
US

V. Phone/Fax

Practice location:
  • Phone: 540-636-0123
  • Fax:
Mailing address:
  • Phone: 540-636-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN A MILLER
Title or Position: MANAGER
Credential:
Phone: 540-678-3588