Provider Demographics
NPI:1912153164
Name:FREDERICKSBURG HEALTH CARE LLC
Entity type:Organization
Organization Name:FREDERICKSBURG HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ALESANTRINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-725-8910
Mailing Address - Street 1:5372 FALLOWATER LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0907
Mailing Address - Country:US
Mailing Address - Phone:540-725-8910
Mailing Address - Fax:540-725-8914
Practice Address - Street 1:6106 HEALTH CENTER LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6687
Practice Address - Country:US
Practice Address - Phone:540-785-1120
Practice Address - Fax:540-785-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004952651Medicaid
367818OtherANTHEM MEDIGAP NUMBER
VA004952651Medicaid