Healthcare Provider Details

I. General information

NPI: 1164585576
Provider Name (Legal Business Name): PETERSBURG HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 SOUTH CRATER ROAD
PETERSBURG VA
23805
US

IV. Provider business mailing address

PO BOX 501128
ST LOUIS MO
63150
US

V. Phone/Fax

Practice location:
  • Phone: 804-765-5000
  • Fax: 804-765-5962
Mailing address:
  • Phone: 804-765-5000
  • Fax: 804-765-5962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565