Healthcare Provider Details

I. General information

NPI: 1346616422
Provider Name (Legal Business Name): FRIENDSHIP HEALTH AND REHAB CENTER SOUTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5647 STARKEY RD
ROANOKE VA
24018-9034
US

IV. Provider business mailing address

PO BOX 7587
ROANOKE VA
24019-0587
US

V. Phone/Fax

Practice location:
  • Phone: 540-265-2100
  • Fax:
Mailing address:
  • Phone: 540-265-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES MICHAEL SHANNON
Title or Position: CFO
Credential:
Phone: 540-265-2100