Provider Demographics
NPI:1093706806
Name:SENTARA LIFE CARE CORPORATION
Entity Type:Organization
Organization Name:SENTARA LIFE CARE CORPORATION
Other - Org Name:SENTARA NURSING CENTER NORFOLK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT SENTARA LIFE CARE
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-892-5400
Mailing Address - Street 1:251 S NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-5718
Mailing Address - Country:US
Mailing Address - Phone:757-892-5400
Mailing Address - Fax:757-892-5401
Practice Address - Street 1:249 S NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-5718
Practice Address - Country:US
Practice Address - Phone:757-892-5500
Practice Address - Fax:757-892-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2681314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-5173-5Medicaid
VA49-6017-3Medicaid
VA49-5173-5Medicaid
VA49-6017-3Medicaid