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General NPI Number Information
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NPI Number | 1124347885
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Entity Type | Organization
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Legal Business Name | DISTRICT 19 COMMUNITY SERVICE BOARD
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 1308 LEMONWOOD DR
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City | HOPEWELL
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State | VA
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Zip | 23860-7619
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Country | US
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Telephone | 804-541-1829
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 LEMONWOOD DR
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City | HOPEWELL
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State | VA
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Zip | 23860-7619
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Country | US
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Telephone | 804-541-1829
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MRS. ELEANOR WILKINS YATES
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Credential |
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Telephone | 804-541-1829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0002044952
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 0002044952
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License Number State | VA
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