SOUTHSIDE VIRGINIA TRAINING CENTER (NPI# 1154330942) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154330942 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE VIRGINIA TRAINING CENTER |
| Practice Address |
26317 West Washington Street Petersburg VA 23803 |
| Practice Telephone | 8045247209 |
| Practice Fax Number | 8045247228 |
| Mailing Telephone | 8045247209 |
| Mailing Fax Number | 8045247228 |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JOHN ALFRED HOLLAND JR. (FACILITY DIRECTOR) |
| Authorized Official Telephone | 8045247209 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| Street Address |
26317 WEST WASHINGTON STREET |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669450276 | Deborah Goodrich Cousins | Pharmacy Technician | 26317 West Washington Street, Petersburg, VA 23803-0030 | 2006-01-04 |
| 1801166988 | Jacquelyn Perry Miller | Registered Nurse | 26317 West Washington Street, Building 66, Petersburg, VA 23842 | 2012-01-06 |
| 1184650947 | Anwar Kamal Abdullah | Internal Medicine | 26317 West Washington Street, Central State Hospital, Petersburg, VA 23803 | 2006-06-23 |
| 1669450912 | Dafferlin Juanita Barnard-dupree | Psychiatry & Neurology | 26317 West Washington Street, Central State Hospital, Petersburg, VA 23803 | 2006-01-06 |
| 1467430751 | Lori Vaughan Mazsure | Pharmacist | 26317 West Washington Street, Petersburg, VA 23803 | 2006-01-06 |
| 1396723987 | Nancy Clay Cook | Pharmacist | 26317 West Washington Street, Petersburg, VA 23803 | 2006-01-04 |
| 1679551188 | Thomas Andrew Ebeling | Psychiatry & Neurology | 26317 West Washington Street, Petersburg, VA 23803-0030 | 2006-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619523719 | Wise Journey Ltd | Home Health | 325-b Brown Street Suite 132, Petersburg, VA 23803 | 2019-08-14 |
| 1386101699 | Marliqua Barnes | Driver | 601 Carter St, Petersburg, VA 23803 | 2019-02-22 |
| 1356596571 | Quality Healthcare Inc | Community/Behavioral Health | 6111 Duncan Rd, Ste F, Petersburg, VA 23803 | 2008-12-02 |
| 1861614943 | Peoples Family Dental Care | Dentist | 1328 W Washington St, Petersburg, VA 23803 | 2007-05-02 |
| 1841333721 | Family Preservation Services, Inc | Community/Behavioral Health | 1000 Patterson Ave, Petersburg, VA 23803 | 2007-02-14 |
| 1154473155 | Progressive Adult Rehabilitation Center, Inc. | Day Training, Developmentally Disabled Services | 114 North Union Street, Suite B, Petersburg, VA 23803 | 2007-01-18 |
| 1861556615 | Evelyn V. Whitehead | Counselor | 115 E Wythe St, Petersburg, VA 23803 | 2006-12-19 |
| 1538248778 | Raymond Gibson Smith Jr. | Dentist | Seventh Avenue, Hiram Davis Medical Center, Petersburg, VA 23803 | 2006-11-06 |
| 1396842282 | Eugene Arthur Richardson IIi | Dentist | 23 Shore Street, Petersburg, VA 23803 | 2006-09-20 |
| 1679594030 | Olumuyiwa Akinniyi Ojediran | Internal Medicine | 734 South Sycamore Street, Petersburg, VA 23803 | 2006-07-21 |
| Find all providers in zip 23803 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063576700 | Rscr West Virginia, Inc | Intermediate Care Facility, Mentally Retarded | 26 Davis St, Petersburg, WV 26847-1535 | 2006-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598381758 | Mount Rogers Community Services | Intermediate Care Facility, Mentally Retarded | 56 Carroll House Ln, Hillsville, VA 24343-3648 | 2020-06-23 |
| 1871123729 | Mount Rogers Community Services | Intermediate Care Facility, Mentally Retarded | 795 Fairview Rd, Wytheville, VA 24382-4501 | 2020-01-20 |
| 1194379529 | Dignity Care Inc | Intermediate Care Facility, Mentally Retarded | 16654 Bolling Brook Ct, Woodbridge, VA 22191-4583 | 2019-07-24 |
| 1821657719 | Hampton-newport News Community Services Board | Intermediate Care Facility, Mentally Retarded | 1421 Aberdeen Rd, Hampton, VA 23666-4027 | 2019-06-13 |
| 1962069054 | Sunny Haven Residental Services | Intermediate Care Facility, Mentally Retarded | 114 Collinswood Dr, Staunton, VA 24401-1988 | 2019-05-23 |
| 1376042523 | Danville Pittsylvania Community Services | Intermediate Care Facility, Mentally Retarded | 505 Keen St, Danville, VA 24540-4657 | 2018-02-02 |
| 1588021596 | Future Alliance LLC | Intermediate Care Facility, Mentally Retarded | 6010 N Crestwood Ave, Suite C, Richmond, VA 23230-2200 | 2016-01-21 |
| 1780052217 | Danville-pittsylvania Community Services | Intermediate Care Facility, Mentally Retarded | 4769 Franklin Tpke, Danville, VA 24540-7807 | 2015-09-15 |
| 1922415934 | Community Residences, Inc. | Intermediate Care Facility, Mentally Retarded | 9332 Burke Rd, Burke, VA 22015-3373 | 2014-07-22 |
| 1891105607 | Horizon Behavioral Health | Intermediate Care Facility, Mentally Retarded | 101 Avoca Ln, Altavista, VA 24517-1154 | 2014-05-01 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23803 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.