Provider Demographics
NPI:1588812549
Name:RUNK AND PRATT OF FOREST
Entity Type:Organization
Organization Name:RUNK AND PRATT OF FOREST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-237-2268
Mailing Address - Street 1:208 GRISTMILL DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2604
Mailing Address - Country:US
Mailing Address - Phone:434-385-8506
Mailing Address - Fax:434-385-6678
Practice Address - Street 1:208 GRISTMILL DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2604
Practice Address - Country:US
Practice Address - Phone:434-385-8506
Practice Address - Fax:434-385-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARO-08129311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102578751Medicaid