Healthcare Provider Details

I. General information

NPI: 1356302988
Provider Name (Legal Business Name): CENTRAL VIRGINIA HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25892 N JAMES MADISON HWY
NEW CANTON VA
23123-2234
US

IV. Provider business mailing address

PO BOX 220
NEW CANTON VA
23123-0220
US

V. Phone/Fax

Practice location:
  • Phone: 434-581-3271
  • Fax: 434-581-2523
Mailing address:
  • Phone: 434-581-3273
  • Fax: 240-368-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201001208
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RODERICK MANIFOLD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 434-581-3273