Healthcare Provider Details

I. General information

NPI: 1740996941
Provider Name (Legal Business Name): LOUDOUN CENTER FOR REHABILITATION AND NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 OLD WATERFORD RD NW
LEESBURG VA
20176-2117
US

IV. Provider business mailing address

1135 E VETERANS HWY
JACKSON NJ
08527-5090
US

V. Phone/Fax

Practice location:
  • Phone: 703-771-2841
  • Fax:
Mailing address:
  • Phone: 617-895-9122
  • Fax:

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: ELAZAR FISCHER
Title or Position: MANAGER
Credential:
Phone: 617-895-9122