Provider Demographics
NPI:1003576273
Name:RURAL RETREAT CARE CENTER, LLC
Entity Type:Organization
Organization Name:RURAL RETREAT CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONCETTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-852-1934
Mailing Address - Street 1:514 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RURAL RETREAT
Mailing Address - State:VA
Mailing Address - Zip Code:24368-3123
Mailing Address - Country:US
Mailing Address - Phone:516-852-1934
Mailing Address - Fax:
Practice Address - Street 1:514 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RURAL RETREAT
Practice Address - State:VA
Practice Address - Zip Code:24368-3123
Practice Address - Country:US
Practice Address - Phone:516-852-1934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility