Healthcare Provider Details

I. General information

NPI: 1407869597
Provider Name (Legal Business Name): MFA X & XLVII - BERKSHIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 CLEARVIEW DR
VINTON VA
24179-3605
US

IV. Provider business mailing address

2917 PENN FOREST BLVD
ROANOKE VA
24018-4374
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-6691
  • Fax: 540-985-4899
Mailing address:
  • Phone: 540-989-3618
  • Fax: 540-774-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2501
License Number StateVA

VIII. Authorized Official

Name: MR. CLAUDE NOVEL MARTIN III
Title or Position: CFO, MFA, INC. GENERAL PARTNER
Credential:
Phone: 540-776-7526