Provider Demographics
NPI:1619120904
Name:BRIDGES AT FARMVILLE
Entity Type:Organization
Organization Name:BRIDGES AT FARMVILLE
Other - Org Name:VIRGINIA BAPTIST HOSPITAL - CENTRA HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:434-947-5700
Mailing Address - Street 1:P.O. BOX 2496
Mailing Address - Street 2:BRIDGES AT FARMVILLE C/O TERESA TATLOCK
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24505-2828
Mailing Address - Country:US
Mailing Address - Phone:434-947-4818
Mailing Address - Fax:434-237-5412
Practice Address - Street 1:646 PERSIMMON TREE FORK
Practice Address - Street 2:BRIDGES AT FARMVILLE ROAD
Practice Address - City:FARMVILLE CITY
Practice Address - State:VA
Practice Address - Zip Code:23901-4349
Practice Address - Country:US
Practice Address - Phone:434-947-5700
Practice Address - Fax:434-947-4565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA BAPTIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA052-14-003323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility