Provider Demographics
NPI:1952527095
Name:SHENANDOAH FAMILY INSTITUTE, INC.
Entity Type:Organization
Organization Name:SHENANDOAH FAMILY INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PETRUSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-667-6272
Mailing Address - Street 1:124 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4114
Mailing Address - Country:US
Mailing Address - Phone:540-667-6272
Mailing Address - Fax:540-542-0406
Practice Address - Street 1:124 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4114
Practice Address - Country:US
Practice Address - Phone:540-667-6272
Practice Address - Fax:540-542-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000087251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10426Medicare PIN