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General NPI Number Information
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NPI Number | 1396768644
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Entity Type | Organization
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Legal Business Name | VIDELL HEALTHCARE DUFFIELD LLC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 11/15/2012
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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 | 24244-5116
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Country | US
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Telephone | 276-431-2841
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Fax | 276-431-2345
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Provider Business Mailing 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 | 24244-0280
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Country | US
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Telephone | 276-431-2841
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Fax | 276-431-4718
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Authorized Official
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Title or Position | EXEC VICE PRES
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Name | MRS. KATHLEEN D MACE
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Credential | RN DCS
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Telephone | 253-277-3197
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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 | NH2664
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License Number State | VA
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