MEDICARE: STANLEYTOWN OPERATIONS 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	:	1376117556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLEYTOWN OPERATIONS LLC

Provider Business Mailing Address
First Line	:	240 RIVERSIDE DR
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-4257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 RIVERSIDE DR
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-4257
Country	:	US
Telephone Number	:	276-629-1772
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KENNEDY FLYNN
Credential	:
Telephone Number	:	276-629-1772

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	05/13/2021

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Directions to “STANLEYTOWN OPERATIONS LLC ” Practice Location

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