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General NPI Number Information
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NPI Number | 1205295896
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Entity Type | Organization
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Legal Business Name | SABER RIDGECREST MANOR
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 157 ROSS CARTER BLVD
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City | DUFFIELD
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State | VA
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Zip | 24244
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Country | US
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Telephone | 276-431-2841
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Fax |
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Provider Business Mailing Address
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Address Line | 1909 GLEN ECHO ROAD
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City | JONESBOROUGH
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State | TN
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Zip | 37659
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Country | US
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Telephone | 423-418-3371
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Fax |
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Authorized Official
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Title or Position | DOR
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Name | REBECCA WOLFORD
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Credential | LPTA
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Telephone | 276-431-2841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | VA
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