Provider Demographics
NPI:1336683101
Name:GL VIRGINIA BLUE RIDGE, LLC
Entity Type:Organization
Organization Name:GL VIRGINIA BLUE RIDGE, LLC
Other - Org Name:GALAX HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-786-8528
Mailing Address - Street 1:836 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2490
Mailing Address - Country:US
Mailing Address - Phone:276-236-9991
Mailing Address - Fax:276-236-5563
Practice Address - Street 1:836 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2490
Practice Address - Country:US
Practice Address - Phone:276-236-9991
Practice Address - Fax:276-236-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA495250Medicare Oscar/Certification