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HAMPTON-NEWPORT NEWS COMMUNITY SERVICES BOARD

Intermediate Care Mentally Retarded

Hampton, Virginia

Provider NPI: 1821657719

Organization Information:
Organization Name:  HAMPTON-NEWPORT NEWS COMMUNITY SERVICES BOARD
Organization is Subpart
Authorized Official:  YAISA ONIKA GOODWIN  CREDENTIALING/PROCUREMENT COORDINAT  757-7880065

Practice Location:
1421 ABERDEEN RD  HAMPTON, VA 23666 US
Tel: 757-251-2244  Fax: 757-224-4950

Business Mailing Address:
300 MEDICAL DR  HAMPTON, VA 23666 US
Tel: 757-788-0300  Fax: --

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded

Other Provider Identifiers:

IssuerNumberStateType
1659424448VA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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