Healthcare Provider Details

I. General information

NPI: 1366654576
Provider Name (Legal Business Name): SENTARA CAREPLEX HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18485 LAKESIDE DR
COURTLAND VA
23837-2629
US

IV. Provider business mailing address

18485 LAKESIDE DR
COURTLAND VA
23837-2629
US

V. Phone/Fax

Practice location:
  • Phone: 757-653-7744
  • Fax:
Mailing address:
  • Phone: 757-653-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN E JOHNSON
Title or Position: SAFETY OFFICER, SECURITY MANAGER
Credential:
Phone: 757-736-0910