Centra Health Inc

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

NH2519 Issued in VA

Legal business name

CENTRA HEALTH INC

Practice address

173 Brockman PK Dr
Amherst, VA 24521

Phone

(434) 947-3777

Fax

(434) 947-4763

NPI assigned

Sep 8, 2006

Organization subpart

No

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

Authorized official

Name

Lewis C Addison

Title

SRVP/Cfo

Phone

(434) 200-4708

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Fairmont Crossing Rehabilitation & Health Care Center Doing business as

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1831293042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2496",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "24505",
            "telephone_number": "434-947-3777",
            "fax_number": "434-947-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 BROCKMAN PK DR",
            "city": "AMHERST",
            "state": "VA",
            "postal_code": "24521",
            "telephone_number": "434-947-3777",
            "fax_number": "434-947-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "ADDISON",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SRVP/CFO",
        "authorized_official_telephone_number": "434-200-4708"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "VA",
            "license": "NH2519",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2519",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000344",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004967232",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairmont Crossing Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenneth Gordon Bunch
• California Lenee Caldwell, RN, MSN, PMHNP-BC
• Judith P Campbell, LPC, LMFT, LSATP
• Ryan Canner, PHARM.D
• Michael Cargill
• Centra Medical Group, LLC
• Centra Medical Group, LLC
• Centra Post Acute Mental Health Services LLC
• Nicole Marie Coffey, NP
• Commonwealth of Virginia State Board of Health

• All providers in Amherst, VA
• Nursing Facility/Intermediate Care Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.