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Organization Active NPI

Halifax Regional Hospital, Inc.

  • Community Based Hospice Care Agency
  • South Boston, VA
National Provider Identifier
1013977933
Registry record updated Feb 5, 2015
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Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HSP-0621 Issued in VA
Legal business name
HALIFAX REGIONAL HOSPITAL, INC.
Practice address
2204 Wilborn Ave
South Boston, VA 24592-1645
Phone
(434) 517-3100
Fax
(434) 575-6752
NPI assigned
Mar 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Kluge
Title
Chief Operating Officer
Phone
(434) 517-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HSP-0621 VA Primary

Addresses

Primary practice location

2204 Wilborn Ave
South Boston, VA 24592-1645

Mailing address

2204 Wilborn Ave
South Boston, VA 24592-1645

Other identifiers 2

IdentifierTypeStateIssuer
442470OtherVAHOSPICE BCBS PROVIDER NUM
4910231MedicaidVA

Other names 1

  • Sentara Halifax Hospice and Palliative Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Feb 2, 2020 Change of OwnershipThis provider was the seller Sentara HospiceCCN 491555, VA, NPI 1194365049

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423094400000",
    "number": "1013977933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "434-517-3100",
            "fax_number": "434-575-6752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALIFAX REGIONAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2015-02-05",
        "status": "A",
        "authorized_official_last_name": "KLUGE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "434-517-3100"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "VA",
            "license": "HSP-0621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPICE BCBS PROVIDER NUM",
            "identifier": "442470",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4910231",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sentara Halifax Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Boston, VA

Sources for this page

Verify at the official NPI Registry.