1891210746 NPI number — EASTERN SHORE COMMUNITY SERVICES BOARD

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 1891210746 NPI number — EASTERN SHORE COMMUNITY SERVICES BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN SHORE 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:
1891210746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 453
Provider Second Line Business Mailing Address:
10129 ROGERS DRIVE
Provider Business Mailing Address City Name:
NASSAWADOX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-442-3636
Provider Business Mailing Address Fax Number:
757-442-2319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19056 GREENBUSH ROAD
Provider Second Line Business Practice Location Address:
EASTERN SHORE BEHAVIOR HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
PARKSLEY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23421-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-465-1260
Provider Business Practice Location Address Fax Number:
757-665-4184
Provider Enumeration Date:
08/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LINTON
Authorized Official First Name:
LYNIEE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
757-442-3636

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  224 , 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)





Copyright © 2007-2025 www.npivalidator.com