Provider Demographics
NPI:1467475830
Name:SKYLINE TERRACE CONVALESCENT HOME
Entity Type:Organization
Organization Name:SKYLINE TERRACE CONVALESCENT HOME
Other - Org Name:SKYLINE TERRACE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:540-459-3738
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:123 LAKEVIEW ROAD
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-0558
Mailing Address - Country:US
Mailing Address - Phone:540-459-3738
Mailing Address - Fax:540-459-8651
Practice Address - Street 1:123 LAKEVIEW ROAD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-0558
Practice Address - Country:US
Practice Address - Phone:540-459-3738
Practice Address - Fax:540-459-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004965892Medicaid