CRATER CHILD DEVELOPMENT CLINIC (NPI# 1164468823) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164468823 |
| Entity Type | Organization |
| Organization Name | CRATER CHILD DEVELOPMENT CLINIC |
| Practice Address |
2002 Wakefield Street Petersburg VA 23805-2112 |
| Mailing Address |
2002 Wakefield Ave Petersburg VA 23805-2112 |
| Practice Telephone | 8048626186 |
| Practice Fax Number | 8048626276 |
| Mailing Telephone | 8048626186 |
| Mailing Fax Number | 8048626276 |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MICHAEL OWEN ROYSTER (DISTRICT HEALTH DIRECTOR) |
| Authorized Official Telephone | 8048631663 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251K00000X | Public Health or Welfare | VA | Agencies |
| Street Address |
2002 WAKEFIELD STREET |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-2112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 251K00000X |
| Grouping | Agencies |
| Classification | Public Health or Welfare |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528106812 | County of Menard | Public Health or Welfare | 1120 N 4th St, Suite A, Petersburg, IL 62675-1115 | 2007-02-01 |
| 1043397110 | Grant County Board of Health | Public Health or Welfare | 739 North Fork Highway, Petersburg, WV 26847 | 2006-11-01 |
| 1598733768 | Community Resource Pharmacy | Public Health or Welfare | 26317 West Washington Street, Extended Building #110, Petersburg, VA 23803 | 2006-03-14 |
| 1285885442 | Pike County Health Department | Public Health or Welfare | 801 E Main St, Petersburg, IN 47567-1249 | 2008-10-07 |
| 1437312576 | Grant Memorial Hospital | Public Health or Welfare | 1 Hospital Drive, Petersburg, WV 26847 | 2008-07-09 |
| 1144339144 | Commonwealth of Virginia State Board of Health | Public Health or Welfare | 301 Halifax St, Petersburg, VA 23803-6335 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326647702 | Lowe Physiotherapy, LLC | Public Health or Welfare | 1220 N Taylor St, Arlington, VA 22201-4814 | 2020-10-18 |
| 1538767793 | Warminster Place LLC | Public Health or Welfare | 7020 Old Mill Road, Norfolk, VA 23518 | 2020-10-11 |
| 1013538719 | Qualified Concepts, LLC | Public Health or Welfare | 15830 Hampton Park Cir, Chesterfield, VA 23832-1900 | 2020-05-04 |
| 1477174472 | Astyra Corporation | Public Health or Welfare | 411 E Franklin St Ste 105, Richmond, VA 23219-2243 | 2020-04-30 |
| 1538780945 | The Eagleforce Foundation Inc | Public Health or Welfare | 13241 Woodland Park Rd Ste 600, Herndon, VA 20171-6401 | 2020-04-27 |
| 1124688536 | Here's 2 Life | Public Health or Welfare | 6023 Riddle Walk, Alexandria, VA 22312-2773 | 2019-06-18 |
| 1750848925 | Aaa Health Care Services LLC | Public Health or Welfare | 9525 Pine Trails Ct, Henrico, VA 23294-5344 | 2019-02-25 |
| 1720523996 | Arthur Chiu | Public Health or Welfare | 7619 Huntmaster Ln, Mc Lean, VA 22102-2531 | 2016-12-27 |
| 1528409257 | Rx4relief, LLC | Public Health or Welfare | 82 Watermans Ct, Gasburg, VA 23857-2204 | 2013-07-10 |
| 1003163338 | Gma Construction LLC | Public Health or Welfare | 166 Holden Dr, Manassas Park, VA 20111-1832 | 2012-08-06 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
Please comment or provide details below to improve the information on CRATER CHILD DEVELOPMENT CLINIC.
| 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.