Healthcare Provider Details

I. General information

NPI: 1669591178
Provider Name (Legal Business Name): CENTRA HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RIVERMONT AVE
LYNCHBURG VA
24503-2030
US

IV. Provider business mailing address

PO BOX 2496
LYNCHBURG VA
24505-2496
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3777
  • Fax: 434-947-4763
Mailing address:
  • Phone: 434-947-3777
  • Fax: 434-947-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH1911
License Number StateVA

VIII. Authorized Official

Name: LEWIS C ADDISON
Title or Position: SRVPCFO
Credential:
Phone: 434-947-4708