Provider Demographics
NPI:1003863648
Name:SHENANDOAH VALLEY CARE, INC.
Entity Type:Organization
Organization Name:SHENANDOAH VALLEY CARE, INC.
Other - Org Name:MONTVUE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:S/T/OWNER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-843-3280
Mailing Address - Street 1:30 MONTVUE DR
Mailing Address - Street 2:P.O. BOX 48
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1057
Mailing Address - Country:US
Mailing Address - Phone:540-743-4571
Mailing Address - Fax:540-743-1986
Practice Address - Street 1:30 MONTVUE DR
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1057
Practice Address - Country:US
Practice Address - Phone:540-743-4571
Practice Address - Fax:540-743-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4952553313M00000X
VA495255314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-5255-3Medicaid
VA49-5255Medicare Oscar/Certification