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General NPI Number Information
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NPI Number | 1558677658
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Entity Type | Organization
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Legal Business Name | MASONIC HOME OF VIRGINIA
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 4101 NINE MILE RD
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City | RICHMOND
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State | VA
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Zip | 23223-4956
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Country | US
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Telephone | 804-222-1694
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Fax | 804-226-4567
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Provider Business Mailing Address
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Address Line | 4101 NINE MILE RD
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City | RICHMOND
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State | VA
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Zip | 23223-4956
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Country | US
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Telephone | 804-222-1694
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Fax | 804-226-4567
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES D COLE
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Credential |
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Telephone | 804-222-1694
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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 | NH2628
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License Number State | VA
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