Healthcare Provider Details

I. General information

NPI: 1649042136
Provider Name (Legal Business Name): ROANOKE REHAB & HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 MECCA ST NE
ROANOKE VA
24012-6219
US

IV. Provider business mailing address

1047 MECCA ST NE
ROANOKE VA
24012-6219
US

V. Phone/Fax

Practice location:
  • Phone: 540-924-0100
  • Fax:
Mailing address:
  • Phone:
  • 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: AKIVA SHAPIRO
Title or Position: COO
Credential:
Phone: 201-581-6622