Provider Demographics
NPI:1861637191
Name:CENTRA PACE
Entity Type:Organization
Organization Name:CENTRA PACE
Other - Org Name:CENTRA PACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:434-200-6516
Mailing Address - Street 1:407 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-2423
Mailing Address - Country:US
Mailing Address - Phone:434-200-4190
Mailing Address - Fax:434-200-6263
Practice Address - Street 1:407 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-2423
Practice Address - Country:US
Practice Address - Phone:434-200-4190
Practice Address - Fax:434-200-6263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization