Healthcare Provider Details

I. General information

NPI: 1689475550
Provider Name (Legal Business Name): EASTERN SKY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 W MAIN STREET
MARSHALL VA
20115-2018
US

IV. Provider business mailing address

PO BOX 1030
MARSHALL VA
20116-1030
US

V. Phone/Fax

Practice location:
  • Phone: 540-729-0001
  • Fax: 571-699-0442
Mailing address:
  • Phone: 540-729-0001
  • Fax: 571-699-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT PAUL LAWRENCE
Title or Position: CEO
Credential: MBA
Phone: 540-729-0001