Provider Demographics
NPI:1104827732
Name:VIRGINIA GAY HOSPITAL INC.
Entity Type:Organization
Organization Name:VIRGINIA GAY HOSPITAL INC.
Other - Org Name:VIRGINIA GAY HOSPITAL HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-472-6260
Mailing Address - Street 1:502 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-2254
Mailing Address - Country:US
Mailing Address - Phone:319-472-6360
Mailing Address - Fax:319-472-5976
Practice Address - Street 1:502 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-2254
Practice Address - Country:US
Practice Address - Phone:319-472-6360
Practice Address - Fax:319-472-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670638Medicaid
IA0670638Medicaid
IA167063Medicare Oscar/Certification