Provider Demographics
NPI:1548292170
Name:BETH SHOLOM HOME OF VIRGINIA
Entity type:Organization
Organization Name:BETH SHOLOM HOME OF VIRGINIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:BELLOTTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-421-5352
Mailing Address - Street 1:PO BOX 29331
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23242-0331
Mailing Address - Country:US
Mailing Address - Phone:804-750-2183
Mailing Address - Fax:804-750-1078
Practice Address - Street 1:1600 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-8110
Practice Address - Country:US
Practice Address - Phone:804-750-2183
Practice Address - Fax:804-750-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2503314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA216278OtherANTHEM PROVIDER #
VA004952910Medicaid
VA49-5291Medicare Oscar/Certification
VA0605910002Medicare NSC