Healthcare Provider Details

I. General information

NPI: 1598796674
Provider Name (Legal Business Name): BIRDMONT HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 HOLSTON RD
WYTHEVILLE VA
24382-4105
US

IV. Provider business mailing address

990 HOLSTON RD
WYTHEVILLE VA
24382-4105
US

V. Phone/Fax

Practice location:
  • Phone: 276-228-5595
  • Fax: 276-228-7343
Mailing address:
  • Phone: 276-228-5595
  • Fax: 276-228-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2481
License Number StateVA

VIII. Authorized Official

Name: MRS. MARYA J MORRISON
Title or Position: CFO
Credential:
Phone: 727-723-3000