Provider Demographics
NPI:1386697217
Name:RUXTON HEALTH OF WINCHESTER, LLC
Entity type:Organization
Organization Name:RUXTON HEALTH OF WINCHESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EAMONN
Authorized Official - Middle Name:DENNIS
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:410-715-8900
Mailing Address - Fax:410-715-8786
Practice Address - Street 1:110 LAUCK DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-4282
Practice Address - Country:US
Practice Address - Phone:540-667-7830
Practice Address - Fax:540-667-2941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUXTON HEALTH CARE I, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
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
VA49653070Medicaid
495389Medicare Oscar/Certification