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General NPI Number Information
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NPI Number | 1689475550
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Entity Type | Organization
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Legal Business Name | EASTERN SKY HEALTH, INC.
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 8354 W MAIN STREET
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City | MARSHALL
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State | VA
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Zip | 20115-2018
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Country | US
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Telephone | 540-729-0001
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Fax | 571-699-0442
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Provider Business Mailing Address
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Address Line | PO BOX 1030
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City | MARSHALL
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State | VA
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Zip | 20116-1030
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Country | US
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Telephone | 540-729-0001
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Fax | 571-699-0442
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT PAUL LAWRENCE
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Credential | MBA
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Telephone | 540-729-0001
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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