Provider Demographics
NPI:1194746032
Name:LOUDOUN NURSING AND REHABILIATION CENTER
Entity type:Organization
Organization Name:LOUDOUN NURSING AND REHABILIATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-472-8717
Mailing Address - Street 1:8095 INNOVATION PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4868
Mailing Address - Country:US
Mailing Address - Phone:540-272-7378
Mailing Address - Fax:703-771-2800
Practice Address - Street 1:235 OLD WATERFORD RD NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2117
Practice Address - Country:US
Practice Address - Phone:703-771-2841
Practice Address - Fax:703-771-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH 2612314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA495275Medicare ID - Type Unspecified
495275Medicare Oscar/Certification