Healthcare Provider Details

I. General information

NPI: 1730755778
Provider Name (Legal Business Name): DEPAUL VA OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6403 GRANBY ST
NORFOLK VA
23505-4447
US

IV. Provider business mailing address

980 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3301
US

V. Phone/Fax

Practice location:
  • Phone: 757-451-2400
  • Fax:
Mailing address:
  • Phone: 757-451-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DEVORA KIRSCHNER
Title or Position: VP OF ADMINISTRATIVE SERVICES
Credential:
Phone: 757-451-2400