| Organization Name: | VIRGINIA DEPARTMENT OF HEALTH |
| NPI Number: | 1811958200 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHNNY WILLIS (BUSINESS MANAGER) |
| Mailing Address: | 1051 Rosebud Rd Grundy |
| State: | VA US |
| Postal Code: | 246140618 |
| Phone Number: | 2769354677 |
| Fax Number: | 2769354537 |
| NPI Enumeration Date: | 03/28/2006 |
| NPI Last Update Date: | 06/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |