Provider Demographics
NPI:1851315261
Name:RUXTON HEALTH CARE III, LLC
Entity Type:Organization
Organization Name:RUXTON HEALTH CARE III, LLC
Other - Org Name:RUXTON HEALTH OF WOODBRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EAMONN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-715-8900
Mailing Address - Street 1:14906 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4016
Mailing Address - Country:US
Mailing Address - Phone:703-491-6167
Mailing Address - Fax:703-491-6969
Practice Address - Street 1:14906 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4016
Practice Address - Country:US
Practice Address - Phone:703-491-6167
Practice Address - Fax:703-491-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2733314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4953614Medicaid
VA4953614Medicaid