Basic Information
| Provider Information | |||||||||
| NPI: | 1275041600 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORFOLK AREA SENIOR CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GREENBRIER REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24641 US HIGHWAY 19 N | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337635007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274995224 | ||||||||
| FaxNumber: | 7274995224 | ||||||||
| Practice Location | |||||||||
| Address1: | 1017 GEORGE WASHINGTON HWY N | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233233505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574855000 | ||||||||
| FaxNumber: | 7574853414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2018 | ||||||||
| LastUpdateDate: | 01/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | FISK | ||||||||
| AuthorizedOfficialFirstName: | TRINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 7274995224 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.