Healthcare Provider Details

I. General information

NPI: 1295770162
Provider Name (Legal Business Name): VIRGINIA LUTHERAN HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 BRANDON AVE SW
ROANOKE VA
24018-1441
US

IV. Provider business mailing address

3807 BRANDON AVE SW STE 2440
ROANOKE VA
24018-1477
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-2616
  • Fax: 540-777-0037
Mailing address:
  • Phone: 540-562-5443
  • Fax: 540-562-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1701001951
License Number StateVA

VIII. Authorized Official

Name: MICHAEL BIRD
Title or Position: CFO
Credential:
Phone: 540-562-5443