Provider Demographics
NPI:1184823155
Name:PRINCE WILLIAM COUNTY EARLY INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:PRINCE WILLIAM COUNTY EARLY INTERVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-792-7800
Mailing Address - Street 1:7969 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2885
Mailing Address - Country:US
Mailing Address - Phone:703-792-7800
Mailing Address - Fax:703-792-5699
Practice Address - Street 1:7969 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2885
Practice Address - Country:US
Practice Address - Phone:703-792-7800
Practice Address - Fax:703-792-5699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA187835OtherANTHEM BLUE CROSS BLUE SH
VA187839OtherANTHEM BLUE CROSS BLUE SH
VA187840OtherANTHEM BLUE CROSS BLUE SH