Provider Demographics
NPI:1891786570
Name:HALIFAX REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:HALIFAX REGIONAL HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR THIRD PARTY PAYERS
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:WOMACK
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-517-3156
Mailing Address - Street 1:2204 WILBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1645
Mailing Address - Country:US
Mailing Address - Phone:434-517-3100
Mailing Address - Fax:434-517-3819
Practice Address - Street 1:2204 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1645
Practice Address - Country:US
Practice Address - Phone:434-517-3100
Practice Address - Fax:434-517-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1853314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004952294Medicaid
VA8536228Medicaid
VA000054OtherANTHEM PROVIDER #
VA004900138Medicaid
VA495229Medicare Oscar/Certification