Provider Demographics
NPI:1952651770
Name:CENTRA PACE - FARMVILLE
Entity Type:Organization
Organization Name:CENTRA PACE - FARMVILLE
Other - Org Name:CENTRA PACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-200-4708
Mailing Address - Street 1:1530 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-4512
Mailing Address - Country:US
Mailing Address - Phone:434-315-2890
Mailing Address - Fax:434-392-0333
Practice Address - Street 1:1530 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-4512
Practice Address - Country:US
Practice Address - Phone:434-315-2890
Practice Address - Fax:434-392-0333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-19
Last Update Date:2021-03-30
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