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General NPI Number Information
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NPI Number | 1154535334
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Entity Type | Organization
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Legal Business Name | POWHATAN NURSING HOME, INC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2100 POWHATAN ST
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City | FALLS CHURCH
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State | VA
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Zip | 22043-1940
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Country | US
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Telephone | 703-538-2400
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Fax | 703-538-5583
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Provider Business Mailing Address
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Address Line | 2100 POWHATAN ST
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City | FALLS CHURCH
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State | VA
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Zip | 22043-1940
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Country | US
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Telephone | 703-538-2400
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Fax | 703-538-5583
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Authorized Official
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Title or Position | PRESIDENTADMINISTRATOR
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Name | MS. CYNTHIA LYNN BUTLER
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Credential | LNHA
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Telephone | 703-538-2400
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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 | NH2656
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License Number State | VA
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