Healthcare Provider Details

I. General information

NPI: 1346418316
Provider Name (Legal Business Name): ELK HILL FARM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 ELK HILL ROAD
GOOCHLAND VA
23063
US

IV. Provider business mailing address

PO BOX 99
GOOCHLAND VA
23063-0099
US

V. Phone/Fax

Practice location:
  • Phone: 804-457-4866
  • Fax: 804-457-2830
Mailing address:
  • Phone: 804-457-4866
  • Fax: 804-457-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSS25005
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSS38007
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSS19405
License Number StateVA

VIII. Authorized Official

Name: MR. MICHAEL C FARLEY
Title or Position: EXECUTIVE DIRECTOR
Credential: MS
Phone: 804-457-4866