Provider Demographics
NPI:1417956673
Name:SEASIDE THE HEALTH CENTER AT ATLANTIC SHORES, LLC
Entity Type:Organization
Organization Name:SEASIDE THE HEALTH CENTER AT ATLANTIC SHORES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-716-2065
Mailing Address - Street 1:1200 ATLANTIC SHORES DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-7311
Mailing Address - Country:US
Mailing Address - Phone:757-716-2060
Mailing Address - Fax:757-716-2019
Practice Address - Street 1:1200 ATLANTIC SHORES DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-7311
Practice Address - Country:US
Practice Address - Phone:757-716-2060
Practice Address - Fax:757-716-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAERO 03-176310400000X
VANH2678314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA495324Medicare ID - Type Unspecified