Basic Information
| Provider Information | |||||||||
| NPI: | 1588745384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROMAN EAGLE REHABILITATION AND HEALTH CARE CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2526 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245402333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348369510 | ||||||||
| FaxNumber: | 4348361012 | ||||||||
| Practice Location | |||||||||
| Address1: | 2526 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245402333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348369510 | ||||||||
| FaxNumber: | 4348361012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 06/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | SETLIFF | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4348369510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH2675 | VA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4950151 | 05 | VA | MEDICAID |