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NPI Code Detail

MEDICARE: WOODBINE CONVALESCENT & NURSING CARE LLC

MEDICARE: WOODBINE CONVALESCENT & NURSING CARE 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
1314000000XSkilled Nursing FacilityNH2732VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GU8OTHERVABCBS PROVIDER NUMBER
2312386OTHERVAMAMSI/OCI PROVIDER NUMBER

General Provider Information

NPI Number : 1497830038
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOODBINE CONVALESCENT & NURSING CARE LLC
Provider Business Mailing Address
First Line : 12093 GAYTON RD
Second Line :
City : RICHMOND
State : VA
Zip : 23238-3401
Country : US
Telephone Number : 804-521-0550
Fax Number : 804-521-0555
Provider Business Practice Location Address
First Line : 2729 KING ST
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-4008
Country : US
Telephone Number : 703-836-8838
Fax Number : 703-836-2965
Authorized Official
Title or Position : PRESIDENT
Name : MR. GRAHAM L ADELMAN
Credential :
Telephone Number : 804-521-0550
Provider Enumeration Date : 10/25/2006
Last Update Date : 08/22/2020

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