Provider Demographics
NPI:1255727517
Name:PATRICK HENRY BOYS AND GIRLS PLANTATION
Entity type:Organization
Organization Name:PATRICK HENRY BOYS AND GIRLS PLANTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-239-4949
Mailing Address - Street 1:1617A ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5797
Mailing Address - Country:US
Mailing Address - Phone:434-239-4949
Mailing Address - Fax:434-239-4955
Practice Address - Street 1:1617A ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5797
Practice Address - Country:US
Practice Address - Phone:434-239-4949
Practice Address - Fax:434-239-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040052481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty