Provider Demographics
NPI:1306185020
Name:THECROSSING AT IRONBRIDGE
Entity Type:Organization
Organization Name:THECROSSING AT IRONBRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVERTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:804-717-8367
Mailing Address - Street 1:6701 IRONBRIDGE, PARKWAY 23831
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831
Mailing Address - Country:US
Mailing Address - Phone:804-748-7000
Mailing Address - Fax:804-717-8368
Practice Address - Street 1:6701 IRONBRIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831
Practice Address - Country:US
Practice Address - Phone:804-748-7000
Practice Address - Fax:804-717-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA33104A0630X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherEMPLOYEMENT