Provider Demographics
NPI:1740384957
Name:CENTRA HEALTH INC
Entity Type:Organization
Organization Name:CENTRA HEALTH INC
Other - Org Name:BRIDGES AT BRIGHTWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SRVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-947-4708
Mailing Address - Street 1:PO BOX 2496
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VI
Mailing Address - Zip Code:24505
Mailing Address - Country:US
Mailing Address - Phone:434-947-3777
Mailing Address - Fax:434-947-4763
Practice Address - Street 1:1410 KENTMOOR FARM RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572
Practice Address - Country:US
Practice Address - Phone:434-947-3777
Practice Address - Fax:434-947-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA05214002322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children