Provider Demographics
NPI:1245615152
Name:8000 ILIFF DRIVE OPERATIONS LLC
Entity Type:Organization
Organization Name:8000 ILIFF DRIVE OPERATIONS LLC
Other - Org Name:ILIFF NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:8000 ILIFF DR
Mailing Address - Street 2:
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-1235
Mailing Address - Country:US
Mailing Address - Phone:703-560-1000
Mailing Address - Fax:703-560-1010
Practice Address - Street 1:8000 ILIFF DR
Practice Address - Street 2:
Practice Address - City:DUNN LORING
Practice Address - State:VA
Practice Address - Zip Code:22027-1235
Practice Address - Country:US
Practice Address - Phone:703-560-1000
Practice Address - Fax:703-560-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00000314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility