1255448379 NPI number — PATRICK HENRY HOSPITAL, INC.

Table of content: (NPI 1255448379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255448379 NPI number — PATRICK HENRY HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK HENRY HOSPITAL, 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:
RIVERSIDE CONVALESCENT CENTER, MATHEWS
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:
1255448379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATHEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-725-9443
Provider Business Practice Location Address Fax Number:
804-725-3184
Provider Enumeration Date:
08/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AUSTIN
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
757-875-7846

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  49E215 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X , with the licence number: 49E215 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 49E215 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004967348 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 495429 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".