Provider Demographics
NPI:1235142522
Name:OAKWOOD LIVING CENTER OF VIRGINIA
Entity Type:Organization
Organization Name:OAKWOOD LIVING CENTER OF VIRGINIA
Other - Org Name:OAKWOOD NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-887-6311
Mailing Address - Street 1:5520 INDIAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5217
Mailing Address - Country:US
Mailing Address - Phone:757-420-3600
Mailing Address - Fax:
Practice Address - Street 1:5520 INDIAN RIVER ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5217
Practice Address - Country:US
Practice Address - Phone:757-420-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2646314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA227694OtherANTHEM BLUE CROSS
VA004952324Medicaid
VA004952324Medicaid