Healthcare Provider Details

I. General information

NPI: 1346223153
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 IRONBOUND RD
WILLIAMSBURG VA
23188-2652
US

IV. Provider business mailing address

4601 IRONBOUND RD
WILLIAMSBURG VA
23188-2652
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-5241
  • Fax: 757-253-5065
Mailing address:
  • Phone: 757-253-5241
  • Fax: 757-253-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL HERR
Title or Position: HOSPITAL DIRECTOR
Credential: JD
Phone: 757-253-5161