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NPI Code Detail

MEDICARE: PHEASANT RIDGE FACILITY OPERATIONS, LLC

MEDICARE: PHEASANT RIDGE FACILITY 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609884055
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHEASANT RIDGE FACILITY OPERATIONS, LLC
Provider Business Mailing Address
First Line : 4355 PHEASANT RIDGE RD
Second Line :
City : ROANOKE
State : VA
Zip : 24014-5272
Country : US
Telephone Number : 540-725-8210
Fax Number : 540-725-5735
Provider Business Practice Location Address
First Line : 4355 PHEASANT RIDGE RD
Second Line :
City : ROANOKE
State : VA
Zip : 24014-5272
Country : US
Telephone Number : 540-725-8210
Fax Number : 540-725-5735
Authorized Official
Title or Position : MANAGER
Name : TIM LEHNER
Credential :
Telephone Number : 770-698-9040
Provider Enumeration Date : 08/03/2006
Last Update Date : 09/13/2024

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