Healthcare Provider Details

I. General information

NPI: 1962450841
Provider Name (Legal Business Name): HALIFAX REGIONAL LONG TERM CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 ROSEHILL DR
SOUTH BOSTON VA
24592-4843
US

IV. Provider business mailing address

PO BOX 566
SOUTH BOSTON VA
24592-0566
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-4906
  • Fax: 434-572-5223
Mailing address:
  • Phone: 434-517-3497
  • Fax: 434-517-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberNH2736
License Number StateVA

VIII. Authorized Official

Name: MR. STEWART NELSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 434-517-3183