Healthcare Provider Details

I. General information

NPI: 1134856420
Provider Name (Legal Business Name): PULLER VETERANS CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6951 VINT HILL PKWY
WARRENTON VA
20187
US

IV. Provider business mailing address

6951 VINT HILL PKWY
WARRENTON VA
20187
US

V. Phone/Fax

Practice location:
  • Phone: 703-859-2343
  • Fax:
Mailing address:
  • Phone: 703-859-2343
  • 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: MR. BROCK BAKOS
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 703-859-2343