Healthcare Provider Details

I. General information

NPI: 1447362660
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA HIRAM W DAVIS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALBEMARLE AND 7TH STREETS BUILDING 110
PETERSBURG VA
23803-0030
US

IV. Provider business mailing address

PO BOX 4030
PETERSBURG VA
23803-0030
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-7344
  • Fax: 804-524-7148
Mailing address:
  • Phone: 804-524-7344
  • Fax: 804-524-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. JARVIS T GRIFFIN
Title or Position: FACILITY DIRECTOR/CEO
Credential: DHA, LNHA, CPHQ
Phone: 804-524-7112