1063545176 NPI number — SOUTHAMPTON BEHAVIORAL HEALTHCARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063545176 NPI number — SOUTHAMPTON BEHAVIORAL HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHAMPTON BEHAVIORAL HEALTHCARE, LLC
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:
1063545176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 633
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23851-0633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-569-0007
Provider Business Mailing Address Fax Number:
757-569-0011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FAIRVIEW DR
Provider Second Line Business Practice Location Address:
BLDG. 2, SUITE 200-B
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23851-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-569-0007
Provider Business Practice Location Address Fax Number:
757-569-0011
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REED,
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-569-0007

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0701003254 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 3450 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 0101050005 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 548467 . This is a "VALUEOPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 069022 . This is a "VALUEOPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 186340 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: O86305M . This is a "SBHS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 186337 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 368995 . This is a "MHN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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