Basic Information
| Provider Information | |||||||||
| NPI: | 1508906702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | H2 REHABILITATION SERVICES OF VIRGINIA, LLC | ||||||||
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| OtherOrganizationName: | H2 HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 484 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322024912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006999395 | ||||||||
| FaxNumber: | 9047579680 | ||||||||
| Practice Location | |||||||||
| Address1: | 1113 CARROLLTON PIKE | ||||||||
| Address2: | |||||||||
| City: | HILLSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243433891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767280700 | ||||||||
| FaxNumber: | 2767280755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | STREETER | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9049444063 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 49-7863-3 | 05 | VA | MEDICAID |