Healthcare Provider Details

I. General information

NPI: 1972140762
Provider Name (Legal Business Name): LINDA HAMPTON SERVICE FACILITATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 11/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARTIN DR
AXTON VA
24054-3662
US

IV. Provider business mailing address

PO BOX 99
AXTON VA
24054-0099
US

V. Phone/Fax

Practice location:
  • Phone: 276-806-9624
  • Fax: 434-685-1356
Mailing address:
  • Phone: 276-806-9624
  • Fax: 434-685-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: