Healthcare Provider Details

I. General information

NPI: 1265463566
Provider Name (Legal Business Name): SNOWSHOE LTC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 LUNENBURG HIGHWAY
KEYSVILLE VA
23947
US

IV. Provider business mailing address

PO BOX 719
KEYSVILLE VA
23947-0719
US

V. Phone/Fax

Practice location:
  • Phone: 434-736-8406
  • Fax: 434-736-9334
Mailing address:
  • Phone: 434-736-8406
  • Fax: 434-736-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberNH2522
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2522
License Number StateVA

VIII. Authorized Official

Name: GALE BOICE
Title or Position: CFO
Credential:
Phone: 252-523-9094