Healthcare Provider Details

I. General information

NPI: 1215080577
Provider Name (Legal Business Name): VALLEY COMMUNITY SERVICES BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 RED TOP ORCHARD RD
WAYNESBORO VA
22980-7437
US

IV. Provider business mailing address

85 SANGERS LN
STAUNTON VA
24401-6712
US

V. Phone/Fax

Practice location:
  • Phone: 540-887-3200
  • Fax:
Mailing address:
  • Phone: 540-887-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number10501001
License Number StateVA

VIII. Authorized Official

Name: DANA L FITZGERALD
Title or Position: QM DIRECTOR
Credential:
Phone: 540-213-7380