Basic Information
| Provider Information | |||||||||
| NPI: | 1508268921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224015719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
| FaxNumber: | 5403713753 | ||||||||
| Practice Location | |||||||||
| Address1: | 5701 LUCAS ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224075704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407852841 | ||||||||
| FaxNumber: | 5407853817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2014 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | BRANSCOME | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | WADE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5408994370 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | 101-01-005 | VA | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | C01242 | 01 | VA | MEDICARE PTAN NUMBER | OTHER |