Provider Demographics
NPI:1336283423
Name:SOUTHERN VIRGINIA MENTAL HEALTH INSTITUTE
Entity Type:Organization
Organization Name:SOUTHERN VIRGINIA MENTAL HEALTH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:N
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:434-773-4216
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:434-773-4216
Mailing Address - Fax:434-773-4292
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:434-773-4216
Practice Address - Fax:434-773-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010014373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008502609Medicaid