Provider Demographics
NPI:1164588570
Name:PLANNING DISTRICT ONE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:PLANNING DISTRICT ONE BEHAVIORAL HEALTH SERVICES
Other - Org Name:FRONTIER HEALTH (FOR CONTRACTED SERVICES)
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-679-5751
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-0904
Mailing Address - Country:US
Mailing Address - Phone:276-679-5751
Mailing Address - Fax:276-679-5754
Practice Address - Street 1:1941 PARK AVE SW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1610
Practice Address - Country:US
Practice Address - Phone:276-679-5751
Practice Address - Fax:276-679-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA315-06-001251B00000X
VA315-07-004251S00000X, 261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945603Medicaid