Healthcare Provider Details

I. General information

NPI: 1215010277
Provider Name (Legal Business Name): AVANTE AT WAYNESBORO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 ROSSER AVE
WAYNESBORO VA
22980-3336
US

IV. Provider business mailing address

4601 SHERIDAN STREET SUITE 500
HOLLYWOOD FL
33021-3439
US

V. Phone/Fax

Practice location:
  • Phone: 540-949-7191
  • Fax: 540-943-1738
Mailing address:
  • Phone: 540-949-7191
  • Fax: 540-943-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2492
License Number StateVA

VIII. Authorized Official

Name: MS. LISA WILSON
Title or Position: PRESIDENT
Credential:
Phone: 954-987-7180