Provider Demographics
NPI:1760579932
Name:BETH SHOLOM REHABILITATION CLINIC
Entity Type:Organization
Organization Name:BETH SHOLOM REHABILITATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:BELLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-421-5352
Mailing Address - Street 1:1600 JOHN ROLFE PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-8110
Mailing Address - Country:US
Mailing Address - Phone:804-421-5352
Mailing Address - Fax:804-750-1078
Practice Address - Street 1:2700 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-8110
Practice Address - Country:US
Practice Address - Phone:804-421-5250
Practice Address - Fax:804-421-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-6686Medicare ID - Type Unspecified