# MASONIC HOME OF VIRGINIA

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

## Provider details

- **NPI number:** 1558677658
- **Authorized official:** MR. JAMES D COLE (CEO)
- **Authorized official phone:** (804) 222-1694

## Contact information

- **Practice address:** 4101 NINE MILE RD, RICHMOND, VA 23223-4956
- **Practice address phone:** (804) 222-1694
- **Practice address fax:** (804) 226-4567
- **Mailing address:** 4101 NINE MILE RD, RICHMOND, VA 23223-4956
- **Mailing address phone:** (804) 222-1694
- **Mailing address fax:** (804) 226-4567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH2628 | VA | Yes |

## Other

- **Enumeration date:** 08/26/2010
- **Last updated:** 08/26/2010