Provider Demographics
NPI:1568413508
Name:COMMONWEATH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEATH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:CHILD DEVELOPMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:540-722-3470
Mailing Address - Street 1:10 BAKER STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4828
Mailing Address - Country:US
Mailing Address - Phone:540-722-3470
Mailing Address - Fax:540-722-3476
Practice Address - Street 1:10 BAKER STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4828
Practice Address - Country:US
Practice Address - Phone:540-722-3470
Practice Address - Fax:540-722-3476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINCHESTER HEALTH DEPT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266491OtherANTHEM/HEALTHKEEPERS
VA004976487Medicaid
VA53215OtherOPTIMA FCARE
VAA80434Medicare UPIN
VA004976487Medicaid