# EDGEMONT CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Edgemont Rehabilitation and Recovery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437149721
- **Authorized official:** MR. SAMUEL A MURDOCH ADMINISTRATOR (ADMINISTRATOR/PRESIDENT OF COMPANY)
- **Authorized official phone:** (276) 228-7380

## Contact information

- **Practice address:** 100 EDGEMONT RD, WYTHEVILLE, VA 24382-4337
- **Practice address phone:** (276) 228-7380
- **Practice address fax:** (276) 228-6811
- **Mailing address:** 100 EDGEMONT RD, WYTHEVILLE, VA 24382-4337
- **Mailing address phone:** (276) 228-7380
- **Mailing address fax:** (276) 228-6811

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH2545 | VA | — |
| 314000000X | Skilled Nursing Facility | NH2545 | VA | Yes |

## Other

- **Enumeration date:** 10/27/2005
- **Last updated:** 10/24/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 265602 | ANTHEM BLUE CROSS BLUE SH | VA |
| 05 | — | 4951751 | — | VA |