Healthcare Provider Details

I. General information

NPI: 1497844294
Provider Name (Legal Business Name): BETH SHOLOM HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 JOHN ROLFE PKWY
RICHMOND VA
23238-8110
US

IV. Provider business mailing address

1600 JOHN ROLFE PKWY
RICHMOND VA
23238-8110
US

V. Phone/Fax

Practice location:
  • Phone: 804-750-2183
  • Fax: 804-750-1078
Mailing address:
  • Phone: 804-750-2183
  • Fax: 804-750-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2503
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN V BELLOTTI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 804-750-2183