Provider Demographics
NPI:1598201014
Name:GL VIRGINIA SHENANDOAH, LLC
Entity Type:Organization
Organization Name:GL VIRGINIA SHENANDOAH, LLC
Other - Org Name:SHENANDOAH VALLEY HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-786-8528
Mailing Address - Street 1:3737 CATALPA AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-9620
Mailing Address - Country:US
Mailing Address - Phone:540-261-7444
Mailing Address - Fax:540-261-2878
Practice Address - Street 1:3737 CATALPA AVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-9620
Practice Address - Country:US
Practice Address - Phone:540-261-7444
Practice Address - Fax:540-261-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
495168Medicare Oscar/Certification