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General NPI Number Information
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NPI Number | 1780929364
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Entity Type | Organization
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Legal Business Name | CENTEL HEALTHCARE INC
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 803 HINTON ST SUITE 308
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City | PETERSBURG
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State | VA
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Zip | 23803-3028
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Country | US
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Telephone | 804-943-6208
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2429 PETERSBURG
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City | PETERSBURG
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State | VA
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Zip | 23804-2429
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Country | US
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Telephone | 804-943-6208
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ACEY TUCKER
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Credential |
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Telephone | 804-943-6208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 07266125
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License Number State | VA
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