Organization
SOUTH BOSTON MANOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. W. STEWART SWAIN (TREASURER)
(843) 902-4582
Entity
Organization
Contact information
Practice address
406 OAK LN, SOUTH BOSTON, VA 24592-1634
(434) 572-2925
(434) 572-8258
Mailing address
406 OAK LN, SOUTH BOSTON, VA 24592-1634
(434) 572-2925
(434) 572-8258
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2704
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010053650
—
VA
Enumeration date
09/29/2005
Last updated
11/02/2011
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