Provider Demographics
NPI:1700300423
Name:CAMPOS BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:CAMPOS BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-891-7891
Mailing Address - Street 1:4701 SPOTSYLVANIA PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9435
Mailing Address - Country:US
Mailing Address - Phone:540-891-7891
Mailing Address - Fax:540-891-2031
Practice Address - Street 1:4701 SPOTSYLVANIA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9435
Practice Address - Country:US
Practice Address - Phone:540-891-7891
Practice Address - Fax:540-891-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168053363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023261195Medicaid