Provider Demographics
NPI:1619388220
Name:MCAP CHRISTIANSBURG LLC
Entity Type:Organization
Organization Name:MCAP CHRISTIANSBURG LLC
Other - Org Name:COMMONWEALTH ASSISTED LIVING AT CHRISTIANSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-220-1055
Mailing Address - Street 1:534 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5395
Mailing Address - Country:US
Mailing Address - Phone:434-220-1055
Mailing Address - Fax:434-295-4851
Practice Address - Street 1:201 WHEATLAND CT
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1091
Practice Address - Country:US
Practice Address - Phone:540-382-5200
Practice Address - Fax:540-382-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAALF 1104120310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0050000840Medicaid