Provider Demographics
NPI:1972969871
Name:CENTRA PACE- GRETNA
Entity type:Organization
Organization Name:CENTRA PACE- GRETNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:434-200-7000
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-0498
Mailing Address - Country:US
Mailing Address - Phone:434-200-7000
Mailing Address - Fax:
Practice Address - Street 1:1220 W GRETNA RD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4087
Practice Address - Country:US
Practice Address - Phone:434-200-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTA HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization