Provider Demographics
NPI:1942266515
Name:HOSPITAL FOR EXTENDED RECOVERY
Entity Type:Organization
Organization Name:HOSPITAL FOR EXTENDED RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-388-1700
Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:STE 700
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-1700
Mailing Address - Fax:757-388-1371
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:STE 700
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-1700
Practice Address - Fax:757-388-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH 1858282E00000X
VAH-1858282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004901347Medicaid