Healthcare Provider Details

I. General information

NPI: 1831293042
Provider Name (Legal Business Name): CENTRA HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 BROCKMAN PK DR
AMHERST VA
24521
US

IV. Provider business mailing address

PO BOX 2496
LYNCHBURG VA
24505
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3777
  • Fax: 434-947-4763
Mailing address:
  • Phone: 434-947-3777
  • Fax: 434-947-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2519
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH2519
License Number StateVA

VIII. Authorized Official

Name: LEWIS C ADDISON
Title or Position: SRVP/CFO
Credential:
Phone: 434-200-4708