MEDICARE: CPLACE RURAL RETREAT SNF, 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1366844268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CPLACE RURAL RETREAT SNF, LLC

Provider Business Mailing Address
First Line	:	514 N. MAIN STREET
Second Line	:
City	:	RURAL RETREAT
State	:	VA
Zip	:	24368-3123
Country	:	US
Telephone Number	:	276-613-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 N. MAIN STREET
Second Line	:
City	:	RURAL RETREAT
State	:	VA
Zip	:	24368-3123
Country	:	US
Telephone Number	:	276-613-4700
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MS. LYNDA SUE HEBBELN
Credential	:
Telephone Number	:	727-797-5200

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	09/23/2014

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