Provider Demographics
NPI:1669460788
Name:PAGE MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:PAGE MEMORIAL HOSPITAL, INC.
Other - Org Name:PAGE MEMORIAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:540-743-4561
Mailing Address - Street 1:200 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1000
Mailing Address - Country:US
Mailing Address - Phone:540-743-4561
Mailing Address - Fax:540-743-6792
Practice Address - Street 1:2097 US HWY 340 S
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835
Practice Address - Country:US
Practice Address - Phone:540-743-6033
Practice Address - Fax:540-743-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497056Medicare Oscar/Certification