Provider Demographics
NPI:1942876982
Name:NEWPORT NEWS VA OPCO LLC
Entity Type:Organization
Organization Name:NEWPORT NEWS VA OPCO LLC
Other - Org Name:OLD DOMINION REHABILITATION AND NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORECLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-703-4200
Mailing Address - Street 1:980 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 RIDGEWOOD PKWY
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4415
Practice Address - Country:US
Practice Address - Phone:757-703-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care