Provider Demographics
NPI:1417954140
Name:FRIENDSHIP HEALTH AND REHAB CENTER, INC.
Entity Type:Organization
Organization Name:FRIENDSHIP HEALTH AND REHAB CENTER, INC.
Other - Org Name:FRIENDSHIP MANOR, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:C. MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:540-777-4044
Mailing Address - Street 1:PO BOX 7577
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-0577
Mailing Address - Country:US
Mailing Address - Phone:540-265-2185
Mailing Address - Fax:540-265-2051
Practice Address - Street 1:327 HERSHBERGER RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1983
Practice Address - Country:US
Practice Address - Phone:540-265-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2558314000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0446070001OtherDMERC
VA49-5044-5Medicaid
0446070001OtherDMERC