1659340537 NPI number — SP LEE LLC

Table of content: (NPI 1659340537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659340537 NPI number — SP LEE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SP LEE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEE HEALTH & REHAB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659340537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5372 FALLOWATER LN
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-0907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-725-8910
Provider Business Mailing Address Fax Number:
540-725-8914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 HEALTH CARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNINGTON GAP
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24277-2854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-546-4566
Provider Business Practice Location Address Fax Number:
276-546-6818
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALESANTRINO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
540-725-8910

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH2746 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004953525 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144883 . This is a "MEDIGAP # MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 198187 . This is a "ANTHEM/BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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