Provider Demographics
NPI:1508268921
Name:RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD
Entity Type:Organization
Organization Name:RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BRANSCOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-899-4370
Mailing Address - Street 1:600 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5719
Mailing Address - Country:US
Mailing Address - Phone:540-373-3223
Mailing Address - Fax:540-371-3753
Practice Address - Street 1:5701 LUCAS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5704
Practice Address - Country:US
Practice Address - Phone:540-785-2841
Practice Address - Fax:540-785-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101-01-005320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01242OtherMEDICARE PTAN NUMBER