=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609302835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRY ROBINSON CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2017
-----------------------------------------------------
Last Update Date | 05/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 443 KEMPSVILLE RD
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-4727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-455-6188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 443 KEMPSVILLE RD
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-4727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-455-6188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROBERT E. MCCARTNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-455-6124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 0904009811
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------