Provider Demographics
NPI:1023118437
Name:COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVI
Entity type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL DIRECTOR-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:757-253-5241
Mailing Address - Street 1:4601 IRONBOUND RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2652
Mailing Address - Country:US
Mailing Address - Phone:757-253-5241
Mailing Address - Fax:757-253-5065
Practice Address - Street 1:4601 IRONBOUND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2652
Practice Address - Country:US
Practice Address - Phone:757-253-5241
Practice Address - Fax:757-253-5065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness