South Boston Manor, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH2704 Issued in VA

Legal business name

SOUTH BOSTON MANOR, LLC

Practice address

406 Oak LN
South Boston, VA 24592-1634

Phone

(434) 572-2925

Fax

(434) 572-8258

NPI assigned

Sep 29, 2005

Organization subpart

No

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

Authorized official

Name

Mr. W. Stewart Swain

Title

Treasurer

Phone

(843) 902-4582

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1740277359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 OAK LN",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921634",
            "telephone_number": "434-572-2925",
            "fax_number": "434-572-8258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 OAK LN",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921634",
            "telephone_number": "434-572-2925",
            "fax_number": "434-572-8258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BOSTON MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "SWAIN",
        "authorized_official_first_name": "W.",
        "authorized_official_middle_name": "STEWART",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "843-902-4582",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010053650",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Smith
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• Southside Behavioral Health - Brandon Home

• Skilled Nursing Facility in South Boston, VA
• Providers in South Boston, VA by specialty
• Skilled Nursing Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; 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.