Healthcare Provider Details

I. General information

NPI: 1740239797
Provider Name (Legal Business Name): HOSPICE OF CENTRAL VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BAYBERRY CT SUITE 300
RICHMOND VA
23226-3791
US

IV. Provider business mailing address

50 N. LAURA ST. SUITE 1800
JACKSONVILLE FL
32202-3614
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-0451
  • Fax: 804-281-0954
Mailing address:
  • Phone: 904-493-6745
  • Fax: 904-262-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHSP-0691
License Number StateVA

VIII. Authorized Official

Name: MR. RICH FOGLE
Title or Position: CFO
Credential:
Phone: 904-493-6745