Healthcare Provider Details

I. General information

NPI: 1265924260
Provider Name (Legal Business Name): NASSAWADOX LIFE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9468 HOSPITAL ROAD
NASSAWADOX VA
23413-0176
US

IV. Provider business mailing address

PO BOX 176
NASSAWADOX VA
23413-0176
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-5600
  • Fax: 757-442-9401
Mailing address:
  • Phone: 757-442-5600
  • Fax: 757-442-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2580
License Number State

VIII. Authorized Official

Name: MR. JAMES L HAINES
Title or Position: CCO & GENERAL COUNSEL
Credential: JD
Phone: 540-774-4263