MEDICARE: CENTRAL VIRGINIA HEALTHCARE ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	1864-03-001	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104161959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL VIRGINIA HEALTHCARE ASSOCIATION

Provider Business Mailing Address
First Line	:	2120 STAPLES MILL RD STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2917
Country	:	US
Telephone Number	:	804-937-3688
Fax Number	:	804-447-5190

Provider Business Practice Location Address
First Line	:	2120 STAPLES MILL RD STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2917
Country	:	US
Telephone Number	:	804-937-3688
Fax Number	:	804-447-5190

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DIONA SHEFFIELD
Credential	:
Telephone Number	:	804-937-3688

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	12/05/2012

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