=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750516894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANVILLE HEALTHCARE GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2009
-----------------------------------------------------
Last Update Date | 01/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 RISON ST
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-799-4540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23700 COMMERCE PARK
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-292-5706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM WEISBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-292-5706
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | NH2764
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------