Provider Demographics
NPI:1710993530
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:CHARLOTTESVILLE ALBEMARLE HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:434-972-6219
Mailing Address - Street 1:PO BOX 7546
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-7546
Mailing Address - Country:US
Mailing Address - Phone:434-972-6219
Mailing Address - Fax:434-972-4310
Practice Address - Street 1:1138 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5128
Practice Address - Country:US
Practice Address - Phone:434-972-6219
Practice Address - Fax:434-972-4310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266539OtherANTHEM OF VIRGINIA
VA42009OtherOPTIMA FAMILY CARE
VA004975227Medicaid
VA42009OtherOPTIMA FAMILY CARE
VA266539OtherANTHEM OF VIRGINIA