Healthcare Provider Details

I. General information

NPI: 1306948112
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 ADKINS RD
CHARLES CITY VA
23030-3020
US

IV. Provider business mailing address

7501 ADKINS RD
CHARLES CITY VA
23030-3020
US

V. Phone/Fax

Practice location:
  • Phone: 804-829-2490
  • Fax: 804-829-6702
Mailing address:
  • Phone: 804-829-2490
  • Fax: 804-829-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL LIEN
Title or Position: SUPERVISOR
Credential:
Phone: 804-829-2490