Healthcare Provider Details

I. General information

NPI: 1134180334
Provider Name (Legal Business Name): WESTMINSTER PRESBYTERIAN RETIREMENT COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12191 CLIPPER DR
LAKE RIDGE VA
22192-2237
US

IV. Provider business mailing address

12191 CLIPPER DRIVE
LAKE RIDGE VA
22192
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-3400
  • Fax: 703-643-9812
Mailing address:
  • Phone: 703-496-3400
  • Fax: 703-643-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2720
License Number StateVA

VIII. Authorized Official

Name: MRS. LYNN GREEN
Title or Position: BILLING MANAGER
Credential:
Phone: 240-429-0585