Healthcare Provider Details

I. General information

NPI: 1992767131
Provider Name (Legal Business Name): COMMONWEATLH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6882 MAIN STREET
GLOUCESTER VA
23061-0663
US

IV. Provider business mailing address

PO BOX 663
GLOUCESTER VA
23061-0663
US

V. Phone/Fax

Practice location:
  • Phone: 804-758-2381
  • Fax: 804-758-4828
Mailing address:
  • Phone: 804-758-2381
  • Fax: 804-758-4828

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: MS. SHERRY HOUSE
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-758-2381