Healthcare Provider Details

I. General information

NPI: 1134611726
Provider Name (Legal Business Name): JFC LYNCHBURG MASTER TENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 MURRELL RD
LYNCHBURG VA
24501-2131
US

IV. Provider business mailing address

PO BOX 2568
HICKORY NC
28603-2568
US

V. Phone/Fax

Practice location:
  • Phone: 434-485-9530
  • Fax:
Mailing address:
  • Phone: 828-322-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF1104402
License Number StateVA

VIII. Authorized Official

Name: MR. CHARLES E TREFZGER JR.
Title or Position: MANAGER
Credential:
Phone: 828-322-5535