MEDICARE: RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	101YM0800X	Mental Health Counselor
3	323P00000X	Psychiatric Residential Treatment Facility
4	385H00000X	Respite Care
5	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790742153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD

Provider Business Mailing Address
First Line	:	600 JACKSON ST
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5719
Country	:	US
Telephone Number	:	540-373-3223
Fax Number	:	540-371-3753

Provider Business Practice Location Address
First Line	:	600 JACKSON ST
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5719
Country	:	US
Telephone Number	:	540-373-3223
Fax Number	:	540-371-3753

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOE WICKENS
Credential	:
Telephone Number	:	540-373-3223

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	03/25/2022

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