Provider Demographics
NPI:1730136151
Name:ALLEGHANY HIGHLANDS COMMUNITY SERVICES
Entity Type:Organization
Organization Name:ALLEGHANY HIGHLANDS COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-965-2135
Mailing Address - Street 1:205 E HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1620
Mailing Address - Country:US
Mailing Address - Phone:540-965-2135
Mailing Address - Fax:540-965-2135
Practice Address - Street 1:311 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1635
Practice Address - Country:US
Practice Address - Phone:540-965-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12716001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010199549Medicaid
VA4945034Medicaid
VA240326OtherANTHEM GROUP
VA010199549Medicaid
VAC02692Medicare PIN