Provider Demographics
NPI:1780840108
Name:SHENANDOAH VALLEY JUVENILE CENTER
Entity Type:Organization
Organization Name:SHENANDOAH VALLEY JUVENILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-213-0251
Mailing Address - Street 1:300 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3574
Mailing Address - Country:US
Mailing Address - Phone:540-213-0251
Mailing Address - Fax:540-213-0255
Practice Address - Street 1:300 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3574
Practice Address - Country:US
Practice Address - Phone:540-213-0251
Practice Address - Fax:540-213-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health