Provider Demographics
NPI:1295770162
Name:VIRGINIA LUTHERAN HOMES, INC.
Entity type:Organization
Organization Name:VIRGINIA LUTHERAN HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-562-5443
Mailing Address - Street 1:3807 BRANDON AVE SW STE 2440
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1477
Mailing Address - Country:US
Mailing Address - Phone:540-562-5443
Mailing Address - Fax:540-562-5465
Practice Address - Street 1:3837 BRANDON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1441
Practice Address - Country:US
Practice Address - Phone:540-776-2616
Practice Address - Fax:540-777-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1701001951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA182829OtherANTHEM BC/BS
VA4966279Medicaid
VA495373Medicare ID - Type Unspecified