Provider Demographics
NPI:1740239797
Name:HOSPICE OF CENTRAL VIRGINIA, LLC
Entity Type:Organization
Organization Name:HOSPICE OF CENTRAL VIRGINIA, LLC
Other - Org Name:HOSPICE OF VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-493-6745
Mailing Address - Street 1:50 N. LAURA ST.
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3614
Mailing Address - Country:US
Mailing Address - Phone:904-493-6745
Mailing Address - Fax:904-262-4804
Practice Address - Street 1:1700 BAYBERRY CT
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3791
Practice Address - Country:US
Practice Address - Phone:804-281-0451
Practice Address - Fax:804-281-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHSP-0691251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004910273Medicaid
VA491537Medicare ID - Type UnspecifiedVA MEDICARE