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General NPI Number Information
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NPI Number | 1093706863
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Entity Type | Organization
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Legal Business Name | SENTARA LIFE CARE CORPORATION
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 1604 OLD DONATION PKWY
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3063
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Country | US
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Telephone | 757-496-7100
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Fax | 757-481-1589
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Provider Business Mailing Address
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Address Line | 251 S NEWTOWN RD
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City | NORFOLK
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State | VA
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Zip | 23502-5718
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Country | US
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Telephone | 757-892-5400
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Fax | 757-892-5401
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Authorized Official
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Title or Position | VICE PRESIDENT SENTARA LIFE CARE
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Name | BRUCE ROBERTSON
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Credential |
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Telephone | 757-892-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH2730
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License Number State | VA
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