4355 PHEASANT RIDGE ROAD OPCO LLC
NPI 1629886577
Skilled Nursing Facility in Roanoke, VA

NPI Status: Active since December 24, 2024

Contact Information

4355 PHEASANT RIDGE RD
ROANOKE, VA
ZIP 24014
Phone: (540) 725-8210
Fax: (540) 725-5735

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  • Organization
  • Skilled Nursing Facility
  • CLIA Number: 49D0932195
  • CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
  • CLIA Exp. Date: 08-13-2027

About 4355 PHEASANT RIDGE ROAD OPCO LLC

This page provides the complete NPI Profile along with additional information for 4355 Pheasant Ridge Road Opco Llc, a provider established in Roanoke, Virginia operating as a Skilled Nursing Facility. The healthcare provider is registered in the NPI registry with number 1629886577 assigned on December 2024. The practitioner's primary taxonomy code is 314000000X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's . The authorized official of this NPI record is Tiffany Hoback (Manager)

NPI
1629886577
Provider Legal Name
4355 PHEASANT RIDGE ROAD OPCO LLC
Other Organization Name
Other Name Type
(6)
Entity Type
Organization
Location Address
4355 PHEASANT RIDGE RD ROANOKE, VA 24014
Location Phone
(540) 725-8210
Location Fax
(540) 725-5735
Mailing Address
4355 PHEASANT RIDGE RD ROANOKE, VA 24014
Mailing Phone
(540) 725-8210
Mailing Fax
(540) 725-5735
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
12-24-2024
Last Update Date
03-10-2025
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Skilled Nursing Facility

Taxonomy Code
314000000X
Type
Nursing & Custodial Care Facilities
Taxonomy Description
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

TIFFANY HOBACK

Authorized Official Title
MANAGER
Authorized Official Phone
(770) 698-9040

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
49D0932195
Facility Type
Skilled Nursing Facility/Nursing Facility
Certificate Effective Date
August 14, 2025
Certificate Expiration Date
August 13, 2027
Laboratory Director
KAREN L. BRANDT
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to 4355 Pheasant Ridge Road Opco Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for 4355 PHEASANT RIDGE ROAD OPCO LLC

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1629886577, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 73. The final step is to find the difference between that total and the next multiple of ten (80 - 73 = 7).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
6
Unchanged
Pos 3
2
Doubled → 4
Pos 4
9
Unchanged
Pos 5
8
Doubled → 16 → 1 + 6
Pos 6
8
Unchanged
Pos 7
6
Doubled → 12 → 1 + 2
Pos 8
5
Unchanged
Pos 9
7
Doubled → 14 → 1 + 4
Check
7
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 2 → 4 8 → 16 → 7 6 → 12 → 3 7 → 14 → 5

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 6 + 4 + 9 + 1 + 6 + 8 + 1 + 2 + 5 + 1 + 4 + 24 = 73

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 73 is 80. The difference is the calculated check digit.

80 - 73 = 7
This NPI is valid
The calculated check digit is 7, which matches the last digit of 1629886577.

Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

Family Medicine
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Occupational Therapy Assistant
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapy Assistant
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Occupational Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Occupational Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapy Assistant
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Occupational Therapist (Physical Rehabilitation)
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapy Assistant
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Occupational Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Skilled Nursing Facility
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Occupational Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapist
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Occupational Therapy Assistant
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014
Physical Therapy Assistant
4355 PHEASANT RIDGE RD
ROANOKE, VA 24014

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1629886577, enumerated as an "organization" on December 24, 2024.

The provider is located at 4355 PHEASANT RIDGE RD ROANOKE, VA 24014 and the phone number is (540) 725-8210.

Skilled Nursing Facility with taxonomy code 314000000X.