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General NPI Number Information
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NPI Number | 1326947607
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Entity Type | Organization
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Legal Business Name | ETHEL SENIOR LIVING, LLC
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 1515 MONMOUTH DR
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City | HENRICO
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State | VA
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Zip | 23238-4827
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Country | US
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Telephone | 804-740-1083
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Fax | 804-793-8266
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Provider Business Mailing Address
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Address Line | 504 N ARTHUR ASHE BLVD
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City | RICHMOND
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State | VA
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Zip | 23220-3309
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Country | US
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Telephone | 443-253-3443
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Fax | 804-793-8266
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. JAY L MANN
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Credential |
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Telephone | 443-253-3443
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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 |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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