1073750030 NPI number — CENTRA HEALTH, INC. COMMUNITY BASED MENTAL HEALTH PROGRAMS

Table of content: (NPI 1073750030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073750030 NPI number — CENTRA HEALTH, INC. COMMUNITY BASED MENTAL HEALTH PROGRAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRA HEALTH, INC. COMMUNITY BASED MENTAL HEALTH PROGRAMS
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:
1073750030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 RIVERMONT AVE
Provider Second Line Business Mailing Address:
COMMUNITY BASED MENTAL HEALTH PROGRAMS-CARLA WARNER
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24503-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-525-8447
Provider Business Mailing Address Fax Number:
540-342-5395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3418 ORANGE AVE NE
Provider Second Line Business Practice Location Address:
COMMUNITY BASED MENTAL HEALTH PROGRAMS-CARLA WARNER
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24012-6451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-525-8447
Provider Business Practice Location Address Fax Number:
540-342-5395
Provider Enumeration Date:
01/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WARNER
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
COORDINATOR
Authorized Official Telephone Number:
540-525-8447

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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