# MIZPAH NURSING HOME INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548277734
- **Authorized official:** MRS. MYRTLE D FAULKNER LICENSE \# 1701000047 (NURSING HOME ADMINISTRATOR)
- **Authorized official phone:** (804) 758-5260

## Contact information

- **Practice address:** 74 MIZPAH ROAD, LOCUST HILL, VA 23092-0070
- **Practice address phone:** (804) 758-5260
- **Practice address fax:** (804) 758-0953
- **Mailing address:** PO BOX 70, LOCUST HILL, VA 23092-0070
- **Mailing address phone:** (804) 758-5260
- **Mailing address fax:** (804) 758-0953

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH2632 | VA | Yes |

## Other

- **Enumeration date:** 08/01/2006
- **Last updated:** 08/22/2020