Provider Demographics
NPI:1134107212
Name:RBM OPCO OF LEBANON LLC
Entity Type:Organization
Organization Name:RBM OPCO OF LEBANON LLC
Other - Org Name:MAPLE GROVE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-265-0322
Mailing Address - Street 1:318 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-4614
Mailing Address - Country:US
Mailing Address - Phone:276-889-0733
Mailing Address - Fax:276-889-5443
Practice Address - Street 1:318 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4614
Practice Address - Country:US
Practice Address - Phone:276-889-0733
Practice Address - Fax:276-889-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
442455OtherANTHEM BCBS
VA1134107212Medicaid
442455OtherANTHEM BCBS