Provider Demographics
NPI:1912951369
Name:COMMONWEALTH CENTER FOR CHILDREN AND ADOLESCENTS
Entity Type:Organization
Organization Name:COMMONWEALTH CENTER FOR CHILDREN AND ADOLESCENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUELL
Authorized Official - Suffix:
Authorized Official - Credentials:RNCNS
Authorized Official - Phone:540-332-2101
Mailing Address - Street 1:1355 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-9146
Mailing Address - Country:US
Mailing Address - Phone:540-332-2100
Mailing Address - Fax:540-332-2203
Practice Address - Street 1:1355 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9146
Practice Address - Country:US
Practice Address - Phone:540-332-2100
Practice Address - Fax:540-332-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA297-14-001283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000007824OtherANTHEM BLUE CROSS-BLUE SH
VA0000000007824OtherANTHEM BLUE CROSS-BLUE SH