Healthcare Provider Details

I. General information

NPI: 1851777130
Provider Name (Legal Business Name): BRNURSCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BLUE RIDGE ST
MARTINSVILLE VA
24112-7261
US

IV. Provider business mailing address

1400 CENTREPARK BLVD STE 810
WEST PALM BEACH FL
33401-7412
US

V. Phone/Fax

Practice location:
  • Phone: 276-638-8701
  • Fax: 276-638-2017
Mailing address:
  • Phone: 239-963-3400
  • Fax: 239-963-3410

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: MRS. DORENE MARQUESS FORD
Title or Position: DIRECTOR OF MIS
Credential:
Phone: 239-659-4900