1245422989 NPI number — EASTER SEALS VIRGINIA

Table of content: (NPI 1245422989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245422989 NPI number — EASTER SEALS VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS VIRGINIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245422989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8003 FRANKLIN FARMS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23229-5107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 CAMP EASTER SEALS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24127-9566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-864-5750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAZELBAKER
Authorized Official First Name:
TARA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
804-287-1007

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 170325 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".