1831121060 NPI number — RAI CARE CENTERS OF VIRGINIA I, LLC

Table of content: (NPI 1831121060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831121060 NPI number — RAI CARE CENTERS OF VIRGINIA I, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAI CARE CENTERS OF VIRGINIA I, 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:
RAI-MAIN STREET-NEWPORT NEWS
Provider Other Organization Name Type Code:
5
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:
1831121060
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:
115 EAST PARK DRIVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-661-1100
Provider Business Mailing Address Fax Number:
615-507-3300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23601-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-594-5535
Provider Business Practice Location Address Fax Number:
757-594-5539
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUNDOCK
Authorized Official First Name:
JON
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
615-507-3307

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201037 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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