Provider Demographics
NPI:1184632119
Name:PBJG, INC
Entity Type:Organization
Organization Name:PBJG, INC
Other - Org Name:COMMONWEALTH REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-792-4663
Mailing Address - Street 1:159 EXECUTIVE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4160
Mailing Address - Country:US
Mailing Address - Phone:434-792-4663
Mailing Address - Fax:434-793-7429
Practice Address - Street 1:4545 RIVERSIDE DR.
Practice Address - Street 2:SUITE D
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541
Practice Address - Country:US
Practice Address - Phone:434-797-4357
Practice Address - Fax:434-797-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-6716Medicare ID - Type UnspecifiedOPT