Organization
MIZPAH NURSING HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MYRTLE D FAULKNER LICENSE # 1701000047 (NURSING HOME ADMINISTRATOR)
(804) 758-5260
Entity
Organization
Contact information
Practice address
74 MIZPAH ROAD, LOCUST HILL, VA 23092-0070
(804) 758-5260
(804) 758-0953
Mailing address
PO BOX 70, LOCUST HILL, VA 23092-0070
(804) 758-5260
(804) 758-0953
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH2632
VA
Other
Enumeration date
08/01/2006
Last updated
08/22/2020
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