=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568569762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BAIR FOUNDATION OF VIRGINIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8002 DISCOVERY DR SUITE 212
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-8601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-288-8210
-----------------------------------------------------
Fax | 804-288-8214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 241 HIGH ST
-----------------------------------------------------
City | NEW WILMINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16142-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-946-8711
-----------------------------------------------------
Fax | 724-946-3249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MS. DEBORAH ESBENSHADE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-946-8711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | CO-06-272
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------