Healthcare Provider Details

I. General information

NPI: 1881845972
Provider Name (Legal Business Name): VOOGT REHABLITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 OLD DONATION PKWY
VIRGINIA BEACH VA
23454-3004
US

IV. Provider business mailing address

1851 OLD DONATION PKWY
VIRGINIA BEACH VA
23454-3004
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-7565
  • Fax:
Mailing address:
  • Phone: 757-481-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number879-01-006
License Number StateVA

VIII. Authorized Official

Name: ROBERT VOOGT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 757-481-7565