Provider Demographics
NPI:1013241462
Name:CENTRAL VIRGINIA HEALTH DISTRICT EARLY INTERVENTION
Entity type:Organization
Organization Name:CENTRAL VIRGINIA HEALTH DISTRICT EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICELAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPNP, MSN
Authorized Official - Phone:434-947-2888
Mailing Address - Street 1:1900 THOMSON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1009
Mailing Address - Country:US
Mailing Address - Phone:434-947-2888
Mailing Address - Fax:434-947-2389
Practice Address - Street 1:1900 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1009
Practice Address - Country:US
Practice Address - Phone:434-947-2888
Practice Address - Fax:434-947-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024079452252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA61551OtherCARENET
VA004975359Medicaid
VA052025OtherANTHEM
VA004975260Medicaid
VA052026OtherANTHEM
VA18765OtherOPTIMA
VA22832OtherOPTIMA
VA61553OtherCARENET
VA003374OtherANTHEM
VA004975308Medicaid
VA21236OtherOPTIMA
VA61555OtherCARENET
VA96857OtherOPTIMA
VA96856OtherOPTIMA
VA052024OtherANTHEM
VA61176OtherCARENET
VA087342OtherANTHEM
VA004975111Medicaid
VA004975251Medicaid
VA61557OtherCARENET
VA96856OtherOPTIMA
VA003374OtherANTHEM
VA087342OtherANTHEM
VA61555OtherCARENET
VA600699125Medicare PIN