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General NPI Number Information
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NPI Number | 1962407700
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Entity Type | Organization
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Legal Business Name | CRATER COMMUNITY HOSPICE INC
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 3916 S CRATER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-9202
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Country | US
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Telephone | 804-526-4300
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Fax | 804-526-4924
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Provider Business Mailing Address
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Address Line | 3916 S CRATER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-9202
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Country | US
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Telephone | 804-526-4300
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Fax | 804-526-4337
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Authorized Official
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Title or Position | CEO
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Name | MRS. BRENDA D. MITCHELL
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Credential | RN, MSN, CS, CHPN
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Telephone | 804-526-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 0515-15
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License Number State | VA
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