Organization
SOUTHERN DOMINION HEALTH SYSTEM INC
Active
Other names
Housecalls for the Homebound
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT O. DAVIS LCSW (CEO)
(434) 696-2165
Entity
Organization
Contact information
Practice address
1508 K V ROAD, VICTORIA, VA 23974-0070
(434) 696-2165
(434) 696-1557
Mailing address
PO BOX 70, VICTORIA, VA 23974-0070
(434) 696-2165
(434) 696-1557
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007691084
—
VA
Enumeration date
02/08/2008
Last updated
02/10/2015
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