Healthcare Provider Details

I. General information

NPI: 1689698011
Provider Name (Legal Business Name): RUXTON HEALTH OF WILLIAMSBURG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
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: 757-229-6625
Mailing address:
  • Phone: 757-229-4121
  • Fax: 757-229-6625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2728
License Number StateVA

VIII. Authorized Official

Name: MR. EAMONN DENNIS REILLY
Title or Position: CEO
Credential:
Phone: 410-715-8900