Healthcare Provider Details

I. General information

NPI: 1861637191
Provider Name (Legal Business Name): CENTRA PACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 FEDERAL ST
LYNCHBURG VA
24504-2423
US

IV. Provider business mailing address

407 FEDERAL ST
LYNCHBURG VA
24504-2423
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-4190
  • Fax: 434-200-6263
Mailing address:
  • Phone: 434-200-4190
  • Fax: 434-200-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. GEORGE C GRAHAM
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 434-200-6516