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General NPI Number Information
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NPI Number | 1104902386
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Entity Type | Organization
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Legal Business Name | LONG TERM CARE OF AMERICA-VIRGINIA, INC.
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 5000 MONUMENT AVE SUITE 102
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City | RICHMOND
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State | VA
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Zip | 23230-3600
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Country | US
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Telephone | 804-593-5146
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Fax | 804-477-7243
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Provider Business Mailing Address
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Address Line | 5000 MONUMENT AVE SUITE 102
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City | RICHMOND
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State | VA
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Zip | 23230-3600
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Country | US
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Telephone | 804-593-5146
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Fax | 804-477-7243
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC G NEVIN
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Credential | MD
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Telephone | 804-593-5146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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