Healthcare Provider Details

I. General information

NPI: 1699774067
Provider Name (Legal Business Name): ORANGE COUNTY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DOGWOOD LN
ORANGE VA
22960-1058
US

IV. Provider business mailing address

120 DOGWOOD LN
ORANGE VA
22960-1058
US

V. Phone/Fax

Practice location:
  • Phone: 540-672-2611
  • Fax: 540-672-3187
Mailing address:
  • Phone: 540-672-2611
  • Fax: 540-672-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2647
License Number StateVA

VIII. Authorized Official

Name: MR. VERNON M BAKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 540-672-2611