Provider Demographics
NPI:1922057298
Name:SOUTHWESTERN VIRGINIA TRAINING CENTER
Entity Type:Organization
Organization Name:SOUTHWESTERN VIRGINIA TRAINING CENTER
Other - Org Name:SWVTC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:276-728-1125
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-7328
Mailing Address - Country:US
Mailing Address - Phone:276-728-3121
Mailing Address - Fax:276-728-1103
Practice Address - Street 1:160 TRAINING CENTER RD
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-7328
Practice Address - Country:US
Practice Address - Phone:276-728-3121
Practice Address - Fax:276-728-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4966686Medicaid