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General NPI Number Information
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NPI Number | 1497135727
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Entity Type | Organization
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Legal Business Name | MIZPAH HEALTHCARE GROUP LLC
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 74 MIZPAH ROAD
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City | LOCUST HILL
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State | VA
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Zip | 23092
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Country | US
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Telephone | 804-758-5260
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Fax | 804-758-0953
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Provider Business Mailing Address
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Address Line | 23700 COMMERCE PARK
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City | BEACHWOOD
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State | OH
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Zip | 44122-5827
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Country | US
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Telephone | 216-292-5706
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM I WEISBERG
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Credential |
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Telephone | 216-292-5706
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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 | NH2632
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License Number State | VA
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