Provider Demographics
NPI:1366766271
Name:VIRGINIACARE PHYSICIAN GROUP, LLC
Entity type:Organization
Organization Name:VIRGINIACARE PHYSICIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-827-0000
Mailing Address - Street 1:40 HUNT CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2274
Mailing Address - Country:US
Mailing Address - Phone:757-827-0000
Mailing Address - Fax:
Practice Address - Street 1:40 HUNT CLUB BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2274
Practice Address - Country:US
Practice Address - Phone:757-827-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAERO2009-422310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility