Provider Demographics
NPI:1467887612
Name:LOUISE W. EGGLESTON CENTER, INC.
Entity Type:Organization
Organization Name:LOUISE W. EGGLESTON CENTER, INC.
Other - Org Name:EGGLESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:757-321-6836
Mailing Address - Street 1:51 BATTLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1403
Mailing Address - Country:US
Mailing Address - Phone:757-224-9680
Mailing Address - Fax:757-224-9715
Practice Address - Street 1:51 BATTLE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1403
Practice Address - Country:US
Practice Address - Phone:757-224-9680
Practice Address - Fax:757-224-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1671041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093768921Medicaid