Mizpah Nursing Home Inc

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

NH2632 Issued in VA

Legal business name

MIZPAH NURSING HOME INC

Practice address

74 Mizpah Road
Locust Hill, VA 23092-0070

Phone

(804) 758-5260

Fax

(804) 758-0953

NPI assigned

Aug 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Myrtle D Faulkner, LICENSE # 1701000047

Title

Nursing Home Administrator

Phone

(804) 758-5260

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1548277734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "LOCUST HILL",
            "state": "VA",
            "postal_code": "230920070",
            "telephone_number": "804-758-5260",
            "fax_number": "804-758-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 MIZPAH ROAD",
            "city": "LOCUST HILL",
            "state": "VA",
            "postal_code": "230920070",
            "telephone_number": "804-758-5260",
            "fax_number": "804-758-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIZPAH NURSING HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "MYRTLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "NURSING HOME ADMINISTRATOR",
        "authorized_official_telephone_number": "804-758-5260",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICENSE # 1701000047"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "VA",
            "license": "NH2632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Alexander Cole
• Karen Kaechele Costantino
• Jennifer Nicole Green, LPTA
• Mizpah Healthcare Group LLC (Dockside Health & Rehab Center)
• Loretta Parham-Friday, MA-SLP
• Iva Jean Smith
• Ashley Vanhatten, OTRL

• Nursing Facility/Intermediate Care Facility in Locust Hill, VA
• Providers in Locust Hill, VA by specialty
• Nursing Facility/Intermediate Care Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.