Provider Demographics
NPI:1255449591
Name:COMMONWEALTH OF VA. DEPT OF BEHAVIORAL HLTH&CENTRAL VA TRAINING CENTER
Entity type:Organization
Organization Name:COMMONWEALTH OF VA. DEPT OF BEHAVIORAL HLTH&CENTRAL VA TRAINING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:434-947-6000
Mailing Address - Street 1:521 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-2105
Mailing Address - Country:US
Mailing Address - Phone:434-947-6000
Mailing Address - Fax:434-947-2140
Practice Address - Street 1:521 COLONY RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2105
Practice Address - Country:US
Practice Address - Phone:434-947-6000
Practice Address - Fax:434-947-2140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4901088Medicaid
VA490108Medicare Oscar/Certification