MEDICARE: VIRGINIACARE PHYSICIAN GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	ERO2009-422	VA

General Provider Information

NPI Number	:	1366766271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIACARE PHYSICIAN GROUP, LLC

Provider Business Mailing Address
First Line	:	40 HUNT CLUB BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2274
Country	:	US
Telephone Number	:	757-827-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 HUNT CLUB BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2274
Country	:	US
Telephone Number	:	757-827-0000
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MS. RENA LOUISE THOMAS
Credential	:
Telephone Number	:	757-827-0000

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	03/22/2010

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