# BETH SHOLOM HOME OF EASTERN VIRGINIA

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

## Provider details

- **NPI number:** 1700863636
- **Authorized official:** MR. DAVID R ABRAHAM CEO (VICE-PRESIDENT)
- **Authorized official phone:** (757) 420-2512

## Contact information

- **Practice address:** 6401 AUBURN DR, VIRGINIA BEACH, VA 23464-3601
- **Practice address phone:** (757) 420-2512
- **Practice address fax:** (757) 424-0657
- **Mailing address:** 6401 AUBURN DR, VIRGINIA BEACH, VA 23464-3601
- **Mailing address phone:** (757) 420-2512
- **Mailing address fax:** (757) 424-0657

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH2504 | VA | Yes |

## Other

- **Enumeration date:** 12/30/2005
- **Last updated:** 08/13/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 215344 | ANTHEM BC/BS | VA |
| 01 | — | 335333 | ANTHEM FOR DMERC | VA |
| 05 | — | 4951867 | — | VA |