Provider Demographics
NPI:1124173182
Name:CENTRAL VIRGINIA TRAINING CENTER
Entity type:Organization
Organization Name:CENTRAL VIRGINIA TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MICHELETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MSA, RN
Authorized Official - Phone:434-947-6000
Mailing Address - Street 1:521 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-2105
Mailing Address - Country:US
Mailing Address - Phone:434-947-6000
Mailing Address - Fax:434-947-2140
Practice Address - Street 1:521 COLONY RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2105
Practice Address - Country:US
Practice Address - Phone:434-947-6000
Practice Address - Fax:434-947-2140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA TRAINING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02256Medicare PIN