1457484412 NPI number — PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD

Table of content: (NPI 1457484412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457484412 NPI number — PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD
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:
1457484412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7969 ASHTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20109-2885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-792-7800
Provider Business Mailing Address Fax Number:
703-792-5699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7969 ASHTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20109-2885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-792-7800
Provider Business Practice Location Address Fax Number:
703-792-5699
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEIB
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
703-792-7800

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , 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: 187835 . This is a "ANTHEM BCSB PT REHAB SVCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com