Provider Demographics
NPI:1508154048
Name:SOUTHSIDE COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:SOUTHSIDE COMMUNITY HOSPITAL, INC.
Other - Org Name:CENTRA HOSPICE FARMVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-200-4798
Mailing Address - Street 1:713 OAK ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1119
Mailing Address - Country:US
Mailing Address - Phone:434-315-2885
Mailing Address - Fax:434-315-2889
Practice Address - Street 1:713 OAK ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1119
Practice Address - Country:US
Practice Address - Phone:434-315-2885
Practice Address - Fax:434-315-2889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHSIDE COMMUNITY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-19
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based