Basic Information
| Provider Information | |||||||||
| NPI: | 1164637518 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCKINGHAM MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | RMH CENTER FOR BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 CANTRELL AVE | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645960 | ||||||||
| FaxNumber: | 5404334338 | ||||||||
| Practice Location | |||||||||
| Address1: | 752 OTT ST | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645960 | ||||||||
| FaxNumber: | 5404334338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | DIR OF PHYSICIAN PRACTICE MANAGEMEN | ||||||||
| AuthorizedOfficialTelephone: | 5405645676 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | H 1891 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 521373 | 01 | VA | VALUE OPTIONS GROUP NUMBE | OTHER | 187228 | 01 | VA | COMPSYCH GROUP NUMBER | OTHER | 286716 | 01 | VA | ANTHEM GROUP NUMBER | OTHER |