MEDICARE: CENTRA BEHAVIORAL HEALTH HOSPITAL LLC

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	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1316815012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRA BEHAVIORAL HEALTH HOSPITAL LLC

Provider Business Mailing Address
First Line	:	1155 SIMONS RUN
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-8911
Country	:	US
Telephone Number	:	615-920-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 SIMONS RUN
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-8911
Country	:	US
Telephone Number	:	615-920-7000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	TAYLOR DAVIS
Credential	:
Telephone Number	:	540-470-8753

Provider Enumeration Date	:	10/25/2025
Last Update Date	:	01/30/2026

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