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General NPI Number Information
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NPI Number | 1275174567
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Entity Type | Organization
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Legal Business Name | COLONIAL HEIGHTS OPERATOR LLC
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 831 E ELLERSLIE AVE
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-1720
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Country | US
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Telephone | 804-526-6851
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Fax |
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Provider Business Mailing Address
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Address Line | 831 E ELLERSLIE AVE
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-1720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ELAZAR FISCHER
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Credential |
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Telephone | 804-526-6851
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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 |
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