1487644795 NPI number — SENTARA LIFE CARE CORPORATION

Table of content: (NPI 1487644795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487644795 NPI number — SENTARA LIFE CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENTARA LIFE CARE CORPORATION
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:
Provider Other Organization Name Type Code:
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:
1487644795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 INDEPENDENCE BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23455-6005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-252-0975
Provider Business Mailing Address Fax Number:
757-363-6104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 INDEPENDENCE BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23455-6005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-252-0975
Provider Business Practice Location Address Fax Number:
757-363-6104
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ACHILLEOS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL PHARMACY SPECIALIST
Authorized Official Telephone Number:
757-252-0988

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  0201003712 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 07702 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4835813 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008519251 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19199 . This is a "OPTIMA PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0497061 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 245139 . This is a "ANTHEM PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4437379 . This is a "AETNA PROVIDER#" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com