Basic Information
| Provider Information | |||||||||
| NPI: | 1497922843 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DINWIDDIE HEALTH CARE LLC | ||||||||
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| OtherOrganizationName: | DINWIDDIE HEALTH & REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5372 FALLOWATER LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240180907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407258910 | ||||||||
| FaxNumber: | 5407258914 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 DIAMOND DRIVE | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238037495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045180780 | ||||||||
| FaxNumber: | 8045180787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2008 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | ALESANTRINO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5407258910 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1497922843 | 05 | VA | MEDICAID | 367817 | 01 | ANTHEM MEDIGAP NUMBER | OTHER |