Provider Demographics
NPI:1588745384
Name:ROMAN EAGLE REHABILITATION AND HEALTH CARE CENTER, INC.
Entity type:Organization
Organization Name:ROMAN EAGLE REHABILITATION AND HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SETLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-836-9510
Mailing Address - Street 1:2526 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2333
Mailing Address - Country:US
Mailing Address - Phone:434-836-9510
Mailing Address - Fax:434-836-1012
Practice Address - Street 1:2526 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2333
Practice Address - Country:US
Practice Address - Phone:434-836-9510
Practice Address - Fax:434-836-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2675314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4950151Medicaid
VA4950151Medicaid
VA495015Medicare ID - Type Unspecified