Provider Demographics
NPI:1912062175
Name:RUXTON HEALTH OF NORFOLK, LLC
Entity Type:Organization
Organization Name:RUXTON HEALTH OF NORFOLK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EAMONN
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-715-8900
Mailing Address - Street 1:10420 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:827 NORVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1540
Practice Address - Country:US
Practice Address - Phone:757-853-6281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUXTON HEALTH CARE I, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-27
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4953096Medicaid
495309Medicare Oscar/Certification