Provider Demographics
NPI:1134180334
Name:WESTMINSTER PRESBYTERIAN RETIREMENT COMMUNITY, INC.
Entity type:Organization
Organization Name:WESTMINSTER PRESBYTERIAN RETIREMENT COMMUNITY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-429-0585
Mailing Address - Street 1:12191 CLIPPER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-496-3400
Mailing Address - Fax:703-643-9812
Practice Address - Street 1:12191 CLIPPER DR
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2237
Practice Address - Country:US
Practice Address - Phone:703-496-3400
Practice Address - Fax:703-643-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2720314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA495280Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
VA49-6704Medicare UPIN