Healthcare Provider Details

I. General information

NPI: 1922686559
Provider Name (Legal Business Name): RICHFIELD LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
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: 540-380-4500
  • Fax:
Mailing address:
  • Phone: 540-380-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: EDITH WOODFORD
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 540-380-6557