Provider Demographics
NPI:1407869597
Name:MFA X & XLVII - BERKSHIRE
Entity Type:Organization
Organization Name:MFA X & XLVII - BERKSHIRE
Other - Org Name:BERKSHIRE HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, MFA, INC. GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:NOVEL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:540-776-7526
Mailing Address - Street 1:2917 PENN FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4374
Mailing Address - Country:US
Mailing Address - Phone:540-989-3618
Mailing Address - Fax:540-774-9443
Practice Address - Street 1:705 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-3605
Practice Address - Country:US
Practice Address - Phone:540-982-6691
Practice Address - Fax:540-985-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2501314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4952936Medicaid
495293Medicare Oscar/Certification