Provider Demographics
NPI:1215390380
Name:CENTRAL PARK BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CENTRAL PARK BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:LAVONNE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-469-0332
Mailing Address - Street 1:610 THIMBLE SHOALS BLVD STE 202B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4511
Mailing Address - Country:US
Mailing Address - Phone:757-327-0203
Mailing Address - Fax:757-903-0531
Practice Address - Street 1:610 THIMBLE SHOALS BLVD STE 202B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4511
Practice Address - Country:US
Practice Address - Phone:757-327-0203
Practice Address - Fax:757-327-0228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESTINY'S HOUSE RESIDENTIAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-05
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health