1891210746 NPI number — EASTERN SHORE COMMUNITY SERVICES BOARD

Table of content: (NPI 1891210746)

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)





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