Healthcare Provider Details

I. General information

NPI: 1659340537
Provider Name (Legal Business Name): SP LEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 HEALTH CARE DR
PENNINGTON GAP VA
24277-2854
US

IV. Provider business mailing address

5372 FALLOWATER LN SUITE 200
ROANOKE VA
24018-0907
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-4566
  • Fax: 276-546-6818
Mailing address:
  • Phone: 540-725-8910
  • Fax: 540-725-8914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2746
License Number StateVA

VIII. Authorized Official

Name: JOSEPH ANTHONY ALESANTRINO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 540-725-8910