Basic Information
Provider Information | |||||||||
NPI: | 1710985841 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RICHFIELD LIVING | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | RICHFIELD HEALTH CENTER - SALEM | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3719 KNOLLRIDGE RD | ||||||||
Address2: |   | ||||||||
City: | SALEM | ||||||||
State: | VA | ||||||||
PostalCode: | 241531938 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5403805500 | ||||||||
FaxNumber: | 5403801583 | ||||||||
Practice Location | |||||||||
Address1: | 3615 W MAIN ST | ||||||||
Address2: |   | ||||||||
City: | SALEM | ||||||||
State: | VA | ||||||||
PostalCode: | 241531961 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5403804500 | ||||||||
FaxNumber: | 5403803510 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2005 | ||||||||
LastUpdateDate: | 04/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WOODFORD | ||||||||
AuthorizedOfficialFirstName: | EDITH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ACCOUNTS RECEIVABLE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 5403806557 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BN1400X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 332BP3500X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 314000000X | NH2661 | VA | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
ID Information
ID | Type | State | Issuer | Description | 004950135 | 05 | VA |   | MEDICAID |