Healthcare Provider Details

I. General information

NPI: 1225753700
Provider Name (Legal Business Name): WILLIAMSBURG SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 S MOUNT VERNON AVE
WILLIAMSBURG VA
23185-2835
US

IV. Provider business mailing address

1235 S MOUNT VERNON AVE
WILLIAMSBURG VA
23185-2835
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-4121
  • Fax:
Mailing address:
  • Phone: 757-229-4121
  • 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: JOSEPH LIEBERMAN
Title or Position: VICE PRESIDENT OF PROCUREMENT
Credential:
Phone: 646-275-4510