Provider Demographics
NPI:1821006842
Name:BIRMINGHAM GREEN ADULT CARE RESIDENCE
Entity Type:Organization
Organization Name:BIRMINGHAM GREEN ADULT CARE RESIDENCE
Other - Org Name:BIRMINGHAM GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MHA NHA CHE
Authorized Official - Phone:703-257-0935
Mailing Address - Street 1:8605 CENTREVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8426
Mailing Address - Country:US
Mailing Address - Phone:703-257-0935
Mailing Address - Fax:703-257-6242
Practice Address - Street 1:8605 CENTREVILLE ROAD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8426
Practice Address - Country:US
Practice Address - Phone:703-257-0935
Practice Address - Fax:703-257-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAWL0041025191310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005003369Medicaid