Provider Demographics
NPI:1932964301
Name:VIRGINIA MISSION HEALTH ACQUISITION LLC
Entity Type:Organization
Organization Name:VIRGINIA MISSION HEALTH ACQUISITION LLC
Other - Org Name:A MISSION FOR MICHAEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-301-2863
Mailing Address - Street 1:30310 RANCHO VIEJO RD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14703 CLOVER HILL RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:VA
Practice Address - Zip Code:20197-1430
Practice Address - Country:US
Practice Address - Phone:703-348-9746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4531-14-009OtherDEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
578314OtherTHE JOINT COMMISSION