MEDICARE: PATRICK HENRY HOSPITAL, INC.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NH2670	VA
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	NH2670	VA
3	313M00000X	Nursing Facility/Intermediate Care Facility	NH2670	VA

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

NPI Number	:	1194830703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK HENRY HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	608 DENBIGH BLVD
Second Line	:	SUITE 600
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-4410
Country	:	US
Telephone Number	:	757-875-2023
Fax Number	:	757-875-2016

Provider Business Practice Location Address
First Line	:	2960 CHELSEA RD
Second Line	:
City	:	WEST POINT
State	:	VA
Zip	:	23181-9793
Country	:	US
Telephone Number	:	804-843-4323
Fax Number	:	804-843-2515

Authorized Official
Title or Position	:	CFO
Name	:	MR. WALTER W AUSTIN
Credential	:
Telephone Number	:	757-875-7846

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/26/2021

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308