Healthcare Provider Details

I. General information

NPI: 1205655206
Provider Name (Legal Business Name): SOUTH HILL VA OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BUENA VISTA CIR
SOUTH HILL VA
23970-1431
US

IV. Provider business mailing address

125 BUENA VISTA CIR
SOUTH HILL VA
23970-1431
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-3151
  • 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