Organization
CENTRA HEALTH INC
Active
Other names
Fairmont Crossing Rehabilitation & Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIS C ADDISON (SRVP/CFO)
(434) 200-4708
Entity
Organization
Contact information
Practice address
173 BROCKMAN PK DR, AMHERST, VA 24521
(434) 947-3777
(434) 947-4763
Mailing address
PO BOX 2496, LYNCHBURG, VA 24505
(434) 947-3777
(434) 947-4763
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH2519
VA
314000000X
Skilled Nursing Facility
NH2519
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000344
ANTHEM
VA
05
—
004967232
—
VA
Enumeration date
09/08/2006
Last updated
11/28/2011
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