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General NPI Number Information
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NPI Number | 1790182160
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Entity Type | Organization
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Legal Business Name | CARE GSL RICHMOND OPCO LLC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 6312 SEVEN CORNERS CENTER #161
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City | FALLS CHURCH
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State | VA
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Zip | 22044
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Country | US
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Telephone | 703-692-9125
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Fax | 703-237-5609
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Provider Business Mailing Address
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Address Line | 501 N. ALLEN AVE
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City | RICHMOND
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State | VA
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Zip | 23220
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Country | US
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Telephone | 804-257-7949
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Fax | 804-257-7949
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Authorized Official
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Title or Position | CEO
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Name | MRS. MATHEW PEPONIS
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Credential |
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Telephone | 804-257-7949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALF1104427
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License Number State | VA
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