Provider Demographics
NPI:1851559876
Name:SHENANDOAH HOUSE AT AMC
Entity Type:Organization
Organization Name:SHENANDOAH HOUSE AT AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-932-4000
Mailing Address - Street 1:111 NORTH CAMPUS LANE
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-245-7320
Mailing Address - Fax:540-245-7328
Practice Address - Street 1:111 NORTH CAMPUS LANE
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-245-7320
Practice Address - Fax:540-245-7328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHC COMMUNITY HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1104076310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility