1376536839 NPI number — COMMONWEALTH HOME NURSING INC

Table of content: (NPI 1376536839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376536839 NPI number — COMMONWEALTH HOME NURSING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH HOME NURSING 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:
COMMONWEALTH HOME NURSING AND HOSPICE, INC
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:
1376536839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 EXECUTIVE DR
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-4160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-792-4663
Provider Business Mailing Address Fax Number:
434-793-7429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-4160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-792-4663
Provider Business Practice Location Address Fax Number:
434-793-7429
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
JANET
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
434-792-4663

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006707 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 71640 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004970691 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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