Basic Information
| Provider Information | |||||||||
| NPI: | 1558329532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLOTTESVILLE POINTE REHABILITATION AND HEALTHCARE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 NORTHWEST DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229012309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349737933 | ||||||||
| FaxNumber: | 4349750248 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 NORTHWEST DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229012309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349737933 | ||||||||
| FaxNumber: | 4349750248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 10/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | MEER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AND SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6296260000 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ORIANNA HEALTH SYSTEMS, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH2546 | VA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4953266 | 05 | VA | MEDICAID |