NPIMap

Organization Active NPI

Centra Pace- Gretna

  • PACE Provider Organization
  • Gretna, VA
National Provider Identifier
1972969871
Registry record updated Jan 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
CENTRA PACE- GRETNA
Practice address
1220 W Gretna Rd
Gretna, VA 24557-4087
Phone
(434) 200-7000
NPI assigned
Jan 7, 2016
Organization subpart
Yes
Parent organization
CENTA HEALTH, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 7, 2016

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

Authorized official

Name
George C Graham, MBA
Title
Executive Director
Phone
(434) 200-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Primary

Addresses

Primary practice location

1220 W Gretna Rd
Gretna, VA 24557-4087

Mailing address

PO Box 498
Gretna, VA 24557-0498
Phone (434) 200-7000

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2109696Centra Pace - Gretna1220 W Gretna Road, Gretna, VA 24557Certificate of waiverFeb 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Centra Health Inc Ta L37 organizations share this tax ID, including this one
Part of
Centra Health Inc Ta L

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452124800000",
    "number": "1972969871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 498",
            "city": "GRETNA",
            "state": "VA",
            "postal_code": "245570498",
            "telephone_number": "434-200-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 W GRETNA RD",
            "city": "GRETNA",
            "state": "VA",
            "postal_code": "245574087",
            "telephone_number": "434-200-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA PACE- GRETNA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTA HEALTH, INC",
        "enumeration_date": "2016-01-07",
        "last_updated": "2016-01-07",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "434-200-7000",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gretna, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.