Healthcare Provider Details

I. General information

NPI: 1396804092
Provider Name (Legal Business Name): HEALTHCARE OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 219 VALUE INN
COVINGTON WV
24901
US

IV. Provider business mailing address

103 MACKLE LN
LEWISBURG WV
24901-1220
US

V. Phone/Fax

Practice location:
  • Phone: 540-747-5403
  • Fax:
Mailing address:
  • Phone: 304-645-3881
  • Fax: 304-645-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number0001169735
License Number StateWV

VIII. Authorized Official

Name: MS. SANDRA POPE MCELWAIN
Title or Position: PARTNER
Credential: NURSE RN BIOPRACTION
Phone: 304-645-3881