Provider Demographics
NPI:1073541645
Name:WESTMINSTER-CANTERBURY ON CHESAPEAKE BAY
Entity Type:Organization
Organization Name:WESTMINSTER-CANTERBURY ON CHESAPEAKE BAY
Other - Org Name:WESTMINSTER-CANTERBURY ON CHESAPEAKE BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-496-1100
Mailing Address - Street 1:3100 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1199
Mailing Address - Country:US
Mailing Address - Phone:757-496-1194
Mailing Address - Fax:757-496-1122
Practice Address - Street 1:3100 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1199
Practice Address - Country:US
Practice Address - Phone:757-496-1194
Practice Address - Fax:757-496-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAELO2006174310400000X
VANH2724313M00000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4951271Medicaid
VA495127Medicare Oscar/Certification
VA4951271Medicaid
VA0801670001Medicare NSC
VAC09611Medicare PIN
VAC09611Medicare PIN