Basic Information
| Provider Information | |||||||||
| NPI: | 1790742153 | ||||||||
| 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: | 600 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224015719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
| FaxNumber: | 5403713753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | WICKENS | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5403733223 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 101YM0800X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 323P00000X | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 385H00000X | N | Respite Care Facility | Respite Care | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 008742511 | 05 | VA | MEDICAID | 004945123 | 05 | VA | MEDICAID | 4978145 | 05 | VA | MEDICAID |