Provider Demographics
NPI:1922102136
Name:CENTRA HEALTH INC
Entity Type:Organization
Organization Name:CENTRA HEALTH INC
Other - Org Name:VIRGINIA BAPTIST HOSPITAL AND GUGGENHEIMER
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:VA
Mailing Address - Zip Code:24505
Mailing Address - Country:US
Mailing Address - Phone:434-947-3777
Mailing Address - Fax:434-947-4763
Practice Address - Street 1:3300 RIVERMONT AVE
Practice Address - Street 2:1902 GRACE ST
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2030
Practice Address - Country:US
Practice Address - Phone:434-947-3777
Practice Address - Fax:434-947-4763
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRA HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-08
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2563313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004960408OtherMEDICAID SPECIALIZED CARE
VA000344OtherANTHEM
VA004951123Medicaid
VA004951123Medicaid