Provider Demographics
NPI:1972686780
Name:VIRGINIA HEALTH REHABILITATION AGENCY, LLC
Entity type:Organization
Organization Name:VIRGINIA HEALTH REHABILITATION AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOLDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-599-7422
Mailing Address - Street 1:240 NAT TURNER BLVD S
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-0020
Mailing Address - Country:US
Mailing Address - Phone:757-595-1946
Mailing Address - Fax:757-596-3621
Practice Address - Street 1:1101 WILLIAM STYRON SQ S
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-594-0330
Practice Address - Fax:757-594-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190031OtherANTHEM SPEECH THERAPY
VA190034OtherANTHEM PHYSICAL THERAPY
VA190035OtherANTHEM OCCUPATIONAL THERA
VA004981103Medicaid
VA190034OtherANTHEM PHYSICAL THERAPY