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General NPI Number Information
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NPI Number | 1497761175
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Entity Type | Organization
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Legal Business Name | MOUNT VERNON NURSING CENTER ASSOCIATES, LLLP
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 8111 TIS WELL DR
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3211
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Country | US
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Telephone | 703-360-4000
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Fax | 703-360-9325
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Provider Business Mailing Address
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Address Line | 8111 TIS WELL DR
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3211
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Country | US
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Telephone | 703-360-4000
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Fax | 703-360-9325
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBERT K DEMARIA
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Credential |
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Telephone | 703-360-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH2634
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH2634
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License Number State | VA
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