Provider Demographics
NPI:1568412831
Name:RUXTON HEALTH CARE VI, LLC
Entity Type:Organization
Organization Name:RUXTON HEALTH CARE VI, LLC
Other - Org Name:RUXTON HEALTH OF ALEXANDRIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EAMONN
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-715-8900
Mailing Address - Street 1:900 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-3200
Mailing Address - Country:US
Mailing Address - Phone:703-684-9100
Mailing Address - Fax:703-684-6195
Practice Address - Street 1:900 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-3200
Practice Address - Country:US
Practice Address - Phone:703-684-9100
Practice Address - Fax:703-684-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2595314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD495203Medicare ID - Type UnspecifiedHIGHMARK MEDICARE