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General NPI Number Information
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NPI Number | 1154823276
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Entity Type | Organization
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Legal Business Name | GREENFIELD ASSISTED LIVING OF SPOTSYLVANIA
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 9300 ONYX CT
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-9329
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Country | US
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Telephone | 540-891-5540
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Fax |
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Provider Business Mailing Address
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Address Line | 125 N WASHINGTON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4515
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Country | US
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Telephone | 703-962-9125
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Fax | 703-237-5609
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Authorized Official
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Title or Position | CEO
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Name | MATHEW PEPONIS
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Credential |
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Telephone | 703-962-9125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | VA
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