Healthcare Provider Details

I. General information

NPI: 1255405015
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HEALTHCENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BUENA VISTA CIR
SOUTH HILL VA
23970-1431
US

IV. Provider business mailing address

PO BOX 90
SOUTH HILL VA
23970-0090
US

V. Phone/Fax

Practice location:
  • Phone: 434-774-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNIE TATUM JR.
Title or Position: VP OF FINANCE, CFO
Credential:
Phone: 434-774-2400