Provider Demographics
NPI:1437128154
Name:CULPEPER BAPTIST RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:CULPEPER BAPTIST RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:540-825-2411
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:12425 VILLAGE LOOP
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-0191
Mailing Address - Country:US
Mailing Address - Phone:540-825-2411
Mailing Address - Fax:
Practice Address - Street 1:12425 VILLAGE LOOP
Practice Address - Street 2:BOX 191
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-0191
Practice Address - Country:US
Practice Address - Phone:540-825-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAWLO055725310400000X
VANH2541313M00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004967658Medicaid
C02076Medicare PIN
VAW36728Medicare UPIN