Basic Information
| Provider Information | |||||||||
| NPI: | 1194361949 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFS OF MARTINSVILLE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5228 VALLEYPOINTE PKWY STE 1 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240193074 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 BLUE RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241127261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766388701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2019 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCLINTIC | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5402650322 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KISSITO HEALTHCARE INC | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.