1194982595 NPI number — BOYDTON COMMUNITY HEALTH FACILITY, INC

Table of content: (NPI 1194982595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194982595 NPI number — BOYDTON COMMUNITY HEALTH FACILITY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOYDTON COMMUNITY HEALTH FACILITY, 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:
Provider Other Organization Name Type Code:
6
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:
1194982595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 540
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYDTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23917-0540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-738-6102
Provider Business Mailing Address Fax Number:
434-738-6982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 JEFFERSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYDTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-738-6102
Provider Business Practice Location Address Fax Number:
434-738-6982
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
434-738-6102

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007691092 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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