MEDICARE: SENTARA LIFE CARE CORPORATION

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	NH2680	VA

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

General Provider Information

NPI Number	:	1528059029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENTARA LIFE CARE CORPORATION

Provider Business Mailing Address
First Line	:	251 S NEWTOWN RD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-5718
Country	:	US
Telephone Number	:	757-892-5400
Fax Number	:	757-892-5401

Provider Business Practice Location Address
First Line	:	2230 EXECUTIVE DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2430
Country	:	US
Telephone Number	:	757-224-2230
Fax Number	:	757-224-2231

Authorized Official
Title or Position	:	VICE PRESIDENT SENTARA LIFE CARE
Name	:	BRUCE ROBERTSON
Credential	:
Telephone Number	:	757-892-5400

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	05/06/2010

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Directions to “SENTARA LIFE CARE CORPORATION ” Practice Location

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