WESTERN TIDEWATER COMMUNITY SERVICES BOARD (NPI# 1689615296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689615296 |
| Entity Type | Organization |
| Organization Name | WESTERN TIDEWATER COMMUNITY SERVICES BOARD |
| Practice Address |
7025 Harbour View Blvd Ste 119 Suffolk VA 23435-2762 |
| Practice Telephone | 7579662805 |
| Practice Fax Number | 7576732586 |
| Mailing Telephone | 7579662805 |
| Mailing Fax Number | 7576732586 |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-09-21 |
| Authorized Official Name | MARION YOUNG (REIMBURSEMENT SUPERVISOR) |
| Authorized Official Telephone | 7579662805 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
084-02-029 | VA | Ambulatory Health Care Facilities |
| N | 251B00000X | Case Management | 084-16-001 | VA | Agencies |
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
084-03-002 | VA | Ambulatory Health Care Facilities |
| N | 343900000X | Non-emergency Medical Transport (VAN) | VA | Transportation Services | |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
084-03-002 | VA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | ANTHEM GROUP NUMBER | 270369 | 01 |
| VA | 004945310 | 05 | |
| VA | 1689615296 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689928996 | Western Tidewater Community Services Board | Intermediate Care Facility, Mentally Retarded | 4373 Pruden Boulevard, Suffolk, VA 23434 | 2012-11-08 |
| 1669558813 | Western Tidewater Community Services Board | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 130 Suburban Dr, Suffolk, VA 23434-2625 | 2006-10-31 |
| 1386687549 | Western Tidewater Community Services Board | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 404 Finney Ave, Suffolk, VA 23434-3852 | 2006-06-14 |
| 1922041177 | Western Tidewater Community Services Board | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1406 Blythewood Ln, Suffolk, VA 23434-2804 | 2006-06-14 |
| 1275574402 | Western Tidewater Community Services Board | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 437 Jackson St, Suffolk, VA 23434-5314 | 2006-06-09 |
| 1104873330 | Western Tidewater Community Services Board | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 22501 Thomas Woods Trl, Zuni, VA 23898-2611 | 2006-05-31 |
| 1164416533 | Western Tidewater Community Services Board | Clinic/Center | 5268 Godwin Blvd, Suffolk, VA 23434-8135 | 2005-08-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | WESTERN TIDEWATER COMMUNITY SERVICES BOARD | 5268 Godwin Blvd, Suffolk, VA 23434-4519 |
| Street Address |
7025 HARBOUR VIEW BLVD STE 119 |
| City | SUFFOLK |
| State | VA |
| Zip Code | 23435-2762 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497307185 | Rachel Nicole Townes | Counselor | 7025 Harbour View Blvd Ste 119, Suffolk, VA 23435-2762 | 2019-07-12 |
| 1992361588 | Amy L. Byrne | Counselor | 7025 Harbour View Blvd Ste 119, Suffolk, VA 23435-2762 | 2019-05-20 |
| 1962066258 | Tanetta Hassell | Social Worker | 7025 Harbour View Blvd Ste 119, Suffolk, VA 23435-2762 | 2019-04-23 |
| 1700364908 | Lacrezia Jackson | Social Worker | 7025 Harbour View Blvd Ste 119, Suffolk, VA 23435-2762 | 2018-07-31 |
| 1801395124 | Brian Eugene Preston | Social Worker | 7025 Harbour View Blvd Ste 119, Suffolk, VA 23435-2762 | 2018-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902423700 | Sean Eric Surber | Physical Therapist | 5818 D Harbour View Blvd., Suite 150, Suffolk, VA 23435 | 2020-06-29 |
| 1871158691 | Lumen Flux Pllc | Dentist | 5501 Bennett's Pasture Road, Suite D, Suffolk, VA 23435 | 2019-05-07 |
| 1588175970 | Louisa Catherine Korte | Anesthesiology | 3107 Summerhouse Drive, Suffolk, VA 23435 | 2017-10-12 |
| 1134648686 | Nicole Short Brown | Non-emergency Medical Transport (VAN) | 782 D Bennetts Meadow Lane, Suffolk, VA 23435 | 2017-09-15 |
| 1104346923 | Southerncare, Inc. | Hospice Care, Community Based | 1037 Champions Way Ste 600, Suffolk, VA 23435 | 2017-06-22 |
| 1801245329 | Usn | Military Hospital | 3602 Traverse Circle, Suffolk, VA 23435 | 2016-06-06 |
| 1366836173 | Vernon Johnson | Counselor | 6805 Castlewood Avenue, Suffolk, VA 23435 | 2015-03-19 |
| 1265776751 | Sister's Developing Growth & Change, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6101 Bradford Drive #b, Suffolk, VA 23435 | 2012-11-21 |
| 1770899247 | Lefcoe, Weinstein, Sachs, Schiff & Associates | Dentist | 210 Meadow View Boulevard, Suffolk, VA 23435 | 2010-08-23 |
| 1770805178 | Nikkiah Wyatt Smith | Counselor | 5705 Lee Farm Ln Ste D, Suffolk, VA 23435 | 2010-02-25 |
| Find all providers in zip 23435 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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|---|---|---|---|---|
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| 1972145357 | Clinical Services, LLC | Clinic/Center | 6651 Everets Rd, Suffolk, VA 23434-6980 | 2019-10-17 |
| 1609418821 | Solid Rock Family Life Center, LLC | Clinic/Center | 140 W Washington St Ste 108, Suffolk, VA 23434-5254 | 2019-10-09 |
| 1962984328 | Box Elder Behavioral Health LLC | Clinic/Center | 1795 Box Elder Road, Suffolk, VA 23437 | 2018-09-02 |
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| 1609490960 | Breakforth Counseling and Consulting LLC | Clinic/Center | 3959 Electric Rd Ste 425, Roanoke, VA 24018-4563 | 2020-06-02 |
| 1861013583 | Spora Medical, PC. | Clinic/Center | 10 Darby Ln, Palmyra, VA 22963-3043 | 2020-05-05 |
| 1295356533 | Monarch Journey Counseling LLC | Clinic/Center | 14125 James Madison Hwy, Orange, VA 22960-2819 | 2020-04-28 |
| 1154941789 | Rocktown Counseling LLC | Clinic/Center | 333 Windermere Dr, Broadway, VA 22815-9489 | 2020-04-23 |
| Find all providers with the same taxonomy | ||||
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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.