Provider Demographics
NPI:1336101039
Name:HOSPITAL AUTHORITY OF NORFOLK
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF NORFOLK
Other - Org Name:LAKE TAYLOR TRANSITIONAL CARE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORSINI
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:757-461-5001
Mailing Address - Street 1:1309 KEMPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2205
Mailing Address - Country:US
Mailing Address - Phone:757-461-5001
Mailing Address - Fax:757-461-4282
Practice Address - Street 1:1309 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2205
Practice Address - Country:US
Practice Address - Phone:757-461-5001
Practice Address - Fax:757-461-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1865313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010294OtherBLUE CROSS
VA215401OtherBLUE CROSS - SNF
VA4951174Medicaid
VA215401OtherBLUE CROSS - SNF
VA010294OtherBLUE CROSS