Basic Information
| Provider Information | |||||||||
| NPI: | 1922672179 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOUISA CARE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230936578 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230936578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409672250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2021 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | BRUCE | ||||||||
| AuthorizedOfficialFirstName: | MONIQUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5409672250 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.