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General NPI Number Information
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NPI Number | 1275686289
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Entity Type | Organization
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Legal Business Name | NELSON WEST HAVEN
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2223 W GRACE ST
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City | RICHMOND
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State | VA
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Zip | 23220-2011
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Country | US
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Telephone | 805-355-9636
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Fax | 804-379-9258
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Provider Business Mailing Address
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Address Line | 2223 W GRACE ST
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City | RICHMOND
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State | VA
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Zip | 23220-2011
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Country | US
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Telephone | 805-355-9636
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Fax | 804-379-9258
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Authorized Official
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Title or Position | OWNER
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Name | ALMA NELSON
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Credential |
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Telephone | 804-355-9636
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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 | CLO-06-486
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License Number State | VA
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