Provider Demographics
NPI:1679542674
Name:COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AND SOUTHERN
Entity type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AND SOUTHERN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:434-773-4220
Mailing Address - Street 1:382 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4023
Mailing Address - Country:US
Mailing Address - Phone:434-799-6220
Mailing Address - Fax:434-773-4274
Practice Address - Street 1:382 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4023
Practice Address - Country:US
Practice Address - Phone:434-799-6220
Practice Address - Fax:434-773-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA494017Medicare ID - Type UnspecifiedMEDICARE A&B