Healthcare Provider Details

I. General information

NPI: 1861595357
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12025 COURTHOUSE RD
NEW KENT VA
23124
US

IV. Provider business mailing address

12025 COURTHOUSE RD P.O. BOX 86
NEW KENT VA
23124
US

V. Phone/Fax

Practice location:
  • Phone: 804-966-9640
  • Fax: 804-966-5210
Mailing address:
  • Phone: 804-966-9640
  • Fax: 804-966-5210

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: MRS. CAROL LIEN
Title or Position: SUPERVISOR
Credential:
Phone: 804-966-9640