Healthcare Provider Details

I. General information

NPI: 1487367769
Provider Name (Legal Business Name): WYTHE VA OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
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: 276-686-7000
  • Fax:
Mailing address:
  • Phone: 276-686-7000
  • 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