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General NPI Number Information
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NPI Number | 1730187048
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Entity Type | Organization
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Legal Business Name | VIRGINIA VETERANS CARE CENTER
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 4550 SHENANDOAH AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-4749
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Country | US
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Telephone | 540-982-2860
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Fax | 540-982-8667
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Provider Business Mailing Address
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Address Line | 4550 SHENANDOAH AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-4749
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Country | US
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Telephone | 540-982-2860
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Fax | 540-982-8667
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WILLIAM VAN THIEL
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Credential |
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Telephone | 540-982-2860
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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 | NH2711
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License Number State | VA
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