Provider Demographics
NPI:1851538359
Name:CERTIFIED SKILLED NURSING SERVICE & ASSOCIATES
Entity Type:Organization
Organization Name:CERTIFIED SKILLED NURSING SERVICE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HAPPINESS
Authorized Official - Middle Name:
Authorized Official - Last Name:EMEJURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-221-2442
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-0224
Mailing Address - Country:US
Mailing Address - Phone:703-221-2442
Mailing Address - Fax:
Practice Address - Street 1:18005 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2473
Practice Address - Country:US
Practice Address - Phone:703-221-2442
Practice Address - Fax:703-221-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09279251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010107237Medicaid