COMMONWEALTH OF VIRGINIA HIRAM W DAVIS MEDICAL CENTER
Intermediate Care Facility, Mental Illness
Petersburg, Virginia
Provider NPI: 1447362660
Organization Information:Organization Name: COMMONWEALTH OF VIRGINIA HIRAM W DAVIS MEDICAL CENTER
Practice Location:
ALBEMARLE AND 7TH STREETS BUILDING 110 PETERSBURG, VA 23803 US
Tel: 804-524-7344 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
ALBEMARLE AND 7TH STREETS BUILDING 110 PETERSBURG, VA 23803 US
Tel: 804-524-7344 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 310500000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mental Illness | VA |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
4967615 | VA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin