Provider Demographics
NPI:1679343651
Name:HAMPTON BLVD OPERATIONS LLC
Entity type:Organization
Organization Name:HAMPTON BLVD OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERON
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-273-1580
Mailing Address - Street 1:1005 HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1505
Mailing Address - Country:US
Mailing Address - Phone:757-623-5602
Mailing Address - Fax:757-623-4646
Practice Address - Street 1:1005 HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1505
Practice Address - Country:US
Practice Address - Phone:757-623-5602
Practice Address - Fax:757-623-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility