Provider Demographics
NPI:1205025020
Name:HP/STANDARDSVILLE, INC.
Entity Type:Organization
Organization Name:HP/STANDARDSVILLE, INC.
Other - Org Name:EVERGREENE NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-619-0866
Mailing Address - Street 1:355 WILLIAM MILLS DR
Mailing Address - Street 2:
Mailing Address - City:STANARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22973-3055
Mailing Address - Country:US
Mailing Address - Phone:434-985-4434
Mailing Address - Fax:434-985-2499
Practice Address - Street 1:355 WILLIAM MILLS DR
Practice Address - Street 2:
Practice Address - City:STANARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22973-3055
Practice Address - Country:US
Practice Address - Phone:434-985-4434
Practice Address - Fax:434-985-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2551314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility