Basic Information
| Provider Information | |||||||||
| NPI: | 1093743031 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRA HEALTH PROFESSIONAL SERVICES, LLC | ||||||||
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| OtherOrganizationName: | THE ACUTE REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1204 FENWICK DR | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245022112 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 RIVERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245032030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342004651 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | LEAVITT | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP PHYSICIAN PRACTICE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4342003656 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTRA HEALTH PROFESSIONAL SERVICES, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.