Healthcare Provider Details

I. General information

NPI: 1689616351
Provider Name (Legal Business Name): HEALTHLINK OF VIRGINIA SHORES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 LYNN SHORES DR
VIRGINIA BEACH VA
23452-2416
US

IV. Provider business mailing address

340 LYNN SHORES DR
VIRGINIA BEACH VA
23452-2416
US

V. Phone/Fax

Practice location:
  • Phone: 757-340-6611
  • Fax: 757-463-4147
Mailing address:
  • Phone: 757-340-6611
  • Fax: 757-463-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2616
License Number StateVA

VIII. Authorized Official

Name: MR. THOMAS D JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 423-478-5953