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Organization
CCSP NOVA LLC
Active
Organization
CCSP NOVA LLC
Active
Other names
Potomac Falls Health & Rehab Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH ANTHONY ALESANTRINO (CHIEF FINANCIAL OFFICER)
(540) 725-8910
Entity
Organization
Contact information
Practice address
46531 HARRY BYRD HWY, STERLING, VA 20164-3555
(703) 834-5800
(703) 834-5905
Mailing address
5372 FALLOWATER LN, SUITE 200, ROANOKE, VA 24018-0907
(540) 725-8910
(540) 725-8914
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2776
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004951794
—
VA
05
—
004960122
—
VA
01
—
417631
ANTHEM MEDIGAP
VA
Enumeration date
08/03/2010
Last updated
01/13/2021
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