MEDICARE: DINWIDDIE HEALTH 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
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	367817	OTHER		ANTHEM MEDIGAP NUMBER

General Provider Information

NPI Number	:	1497922843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DINWIDDIE HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	5372 FALLOWATER LN
Second Line	:	SUITE 200
City	:	ROANOKE
State	:	VA
Zip	:	24018-0907
Country	:	US
Telephone Number	:	540-725-8910
Fax Number	:	540-725-8914

Provider Business Practice Location Address
First Line	:	46 DIAMOND DRIVE
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-7495
Country	:	US
Telephone Number	:	804-518-0780
Fax Number	:	804-518-0787

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JOSEPH ANTHONY ALESANTRINO
Credential	:
Telephone Number	:	540-725-8910

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	01/13/2021

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