Provider Demographics
NPI:1902929649
Name:RETREAT HOSPITAL
Entity Type:Organization
Organization Name:RETREAT HOSPITAL
Other - Org Name:OCCUPATIONAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER (ADULT)
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:MANN
Authorized Official - Last Name:VAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:804-254-5467
Mailing Address - Street 1:6018 S MELBECK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-5283
Mailing Address - Country:US
Mailing Address - Phone:804-714-0228
Mailing Address - Fax:
Practice Address - Street 1:2621 GROVE AVE
Practice Address - Street 2:RETREAT HOSPITAL- OCCUPATIONAL HEALTH
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4308
Practice Address - Country:US
Practice Address - Phone:804-254-5467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017138594282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital