NPIMap

Organization Active NPI

Prince William County Community Services Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manassas, VA
National Provider Identifier
1053402800
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD
Practice address
7969 Ashton Ave
Manassas, VA 20109-2885
Phone
(703) 792-7800
Fax
(703) 792-5699
NPI assigned
Sep 27, 2006
Last updated
Oct 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Ansar Shand
Title
Manager
Phone
(703) 792-7800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

7969 Ashton Ave
Manassas, VA 20109-2885

Mailing address

7969 Ashton Ave
Manassas, VA 20109-2885
Phone (703) 792-7800

Other identifiers 3

IdentifierTypeStateIssuer
004978277MedicaidVA
210245OtherVABLUE CROSS BLUE SHIELD
004945247MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420000249 VA Part B Supplier - Clinic/Group Practice 7113912973 Receives reassigned benefits from 137 practitioners
Practice locations: Manassas, VA; Woodbridge, VA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

14011 Worth Ave
Ste 110
Woodbridge, VA 22192

15941 Donald Curtis Dr
Ste 200
Woodbridge, VA 22191
Phone (703) 792-4900

Practitioners & affiliated clinicians

Practitioners 202

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 202

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383091200000",
    "number": "1053402800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7969 ASHTON AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092885",
            "telephone_number": "703-792-7800",
            "fax_number": "703-792-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7969 ASHTON AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092885",
            "telephone_number": "703-792-7800",
            "fax_number": "703-792-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE WILLIAM COUNTY COMMUNITY SERVICES BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2013-10-30",
        "status": "A",
        "authorized_official_last_name": "SHAND",
        "authorized_official_first_name": "ANSAR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "703-792-7800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004978277",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "210245",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945247",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.