NPIMap

Organization Active NPI

City of Portsmouth

Doing business as Department of Behavioral Healthcare Services

  • Community/Behavioral Health Agency
  • Portsmouth, VA
National Provider Identifier
1093891699
Registry record updated Mar 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
046 Issued in VA
Legal business name
CITY OF PORTSMOUTH
Doing business as
Department of Behavioral Healthcare Services
Practice address
1811 King Street
Portsmouth, VA 23704-3032
Phone
(757) 393-5404
Fax
(757) 393-5405
NPI assigned
Oct 27, 2006
Last updated
Mar 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2020

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

Authorized official

Name
Ms. Mildred Elaine Breathwaite, M. ED,CSAC,QMHP,QSAP
Title
Director/Program Sponsor
Phone
(757) 393-8618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 046 VA Primary

Addresses

Primary practice location

1811 King Street
Portsmouth, VA 23704-3032

Mailing address

1811 King Street
Portsmouth, VA 23704-3032
Phone (757) 393-5404

Other identifiers 1

IdentifierTypeStateIssuer
004945204MedicaidVA

Other names 1

  • Department of Behavioral Healthcare Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 11, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041112000176 VA Part B Supplier - Clinic/Group Practice 9032173877 Receives reassigned benefits from 10 practitioners
Practice locations: Portsmouth, VA
O20200430001981 VA Part B Supplier - Opioid Treatment Program (Otp) 9032173877 Practice locations: Portsmouth, 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
Tax ID family
City of Portsmouth VA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1195 Hodges Ferry Rd
Portsmouth, VA 23701
Phone (757) 465-2932

1601 Effingham St
Portsmouth, VA 23704
Phone (757) 393-8521

1811 King St
Portsmouth, VA 23704
Phone (757) 393-5404

2003 Frederick Blvd
Portsmouth, VA 23704
Phone (757) 393-5115

3230 Victory Blvd
Portsmouth, VA 23702
Phone (757) 558-2818

4001 River Shore Rd
Portsmouth, VA 23703
Phone (757) 686-2525

645 Broad St
Portsmouth, VA 23707
Phone (757) 393-8628

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583452800000",
    "number": "1093891699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 KING STREET",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237043032",
            "telephone_number": "757-393-5404",
            "fax_number": "757-393-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 KING STREET",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237043032",
            "telephone_number": "757-393-5404",
            "fax_number": "757-393-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF PORTSMOUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A",
        "authorized_official_last_name": "BREATHWAITE",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "DIRECTOR/PROGRAM SPONSOR",
        "authorized_official_telephone_number": "757-393-8618",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M. ED,CSAC,QMHP,QSAP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945204",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Department of Behavioral Healthcare Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Department of Behavioral Healthcare Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portsmouth, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2020; 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.