Healthcare Provider Details

I. General information

NPI: 1144230814
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 FLEISHER AVE.
MONTEREY VA
24465
US

IV. Provider business mailing address

140 FLEISHER AVE.
MONTEREY VA
24465
US

V. Phone/Fax

Practice location:
  • Phone: 540-468-2270
  • Fax: 540-468-2502
Mailing address:
  • Phone: 540-468-2270
  • Fax: 540-468-2502

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. KIMBERLY W HABEL
Title or Position: OFFICE SERVICE SUPERVISOR SENIOR
Credential:
Phone: 540-332-7830