Healthcare Provider Details

I. General information

NPI: 1003576273
Provider Name (Legal Business Name): RURAL RETREAT CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N MAIN ST
RURAL RETREAT VA
24368-3123
US

IV. Provider business mailing address

514 N MAIN ST
RURAL RETREAT VA
24368-3123
US

V. Phone/Fax

Practice location:
  • Phone: 516-852-1934
  • Fax:
Mailing address:
  • Phone: 516-852-1934
  • 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: CONCETTO RUTA
Title or Position: OPERATOR/OWNER
Credential:
Phone: 516-852-1934