MEDICARE: COLONIAL BEACH PUBLIC SCHOOLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1780796094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL BEACH PUBLIC SCHOOLS

Provider Business Mailing Address
First Line	:	16 IRVING AVE N
Second Line	:
City	:	COLONIAL BEACH
State	:	VA
Zip	:	22443-2324
Country	:	US
Telephone Number	:	804-224-8080
Fax Number	:	804-224-8357

Provider Business Practice Location Address
First Line	:	16 IRVING AVE N
Second Line	:
City	:	COLONIAL BEACH
State	:	VA
Zip	:	22443-2324
Country	:	US
Telephone Number	:	804-224-8080
Fax Number	:	804-224-8357

Authorized Official
Title or Position	:	DIRECTOR OF FED. PROGRAMS,SPED/GIFT
Name	:	MS. AUDREY SIMMS BERRYMAN
Credential	:	M.S. ED.
Telephone Number	:	804-224-8080

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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