Provider Demographics
NPI:1346231560
Name:SENTARA LIFE CARE CORPORATION
Entity Type:Organization
Organization Name:SENTARA LIFE CARE CORPORATION
Other - Org Name:SENTARA VILLAGE AT VIRGINIA BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT SENTARA LIFE CARE
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-892-5400
Mailing Address - Street 1:251 S NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-5718
Mailing Address - Country:US
Mailing Address - Phone:757-892-5400
Mailing Address - Fax:757-892-5401
Practice Address - Street 1:3751 SENTARA WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4200
Practice Address - Country:US
Practice Address - Phone:757-306-2800
Practice Address - Fax:757-306-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAELO 2004-400310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility