Provider Demographics
NPI:1013410307
Name:LITTLE KESWICK SCHOOL, LLC
Entity Type:Organization
Organization Name:LITTLE KESWICK SCHOOL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-295-0457
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:KESWICK
Mailing Address - State:VA
Mailing Address - Zip Code:22947-0024
Mailing Address - Country:US
Mailing Address - Phone:434-295-0457
Mailing Address - Fax:
Practice Address - Street 1:500 LITTLE KESWICK LN
Practice Address - Street 2:
Practice Address - City:KESWICK
Practice Address - State:VA
Practice Address - Zip Code:22947-2406
Practice Address - Country:US
Practice Address - Phone:434-295-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE KESWICK EDUCATION CORPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X, 221700000X, 225X00000X, 235Z00000X
VA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3024Medicaid