1417944315 NPI number — VIRGINIA HEALTH SERVICES, INC

Table of content: (NPI 1417944315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417944315 NPI number — VIRGINIA HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA HEALTH SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JAMES RIVER CONVALESCENT AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417944315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 NAT TURNER BLVD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-0020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-596-6268
Provider Business Mailing Address Fax Number:
757-595-0966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 ABERTHAW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23601-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-595-2273
Provider Business Practice Location Address Fax Number:
757-595-8625
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOLDY
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
757-599-7422

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH2597 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 227504 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004952863 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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