Provider Demographics
NPI:1649211376
Name:SP FISHERSVILLE, LLC
Entity Type:Organization
Organization Name:SP FISHERSVILLE, LLC
Other - Org Name:AUGUSTA NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:800 CONCOURSE PKWY S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6148
Mailing Address - Country:US
Mailing Address - Phone:407-571-1550
Mailing Address - Fax:407-571-1599
Practice Address - Street 1:35 CROSS ROAD LN
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2331
Practice Address - Country:US
Practice Address - Phone:540-885-8424
Practice Address - Fax:540-885-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2699314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4953363Medicaid
495336Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
VA4953363Medicaid