NPIMap

Organization Active NPI

Eastern Shore Community MH Mr Sas Services Board

Doing business as Eastern Shore Behavioral Healthcare Center

  • Professional Counselor
  • Parksley, VA
National Provider Identifier
1154411510
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
EASTERN SHORE COMMUNITY MH MR SAS SERVICES BOARD
Doing business as
Eastern Shore Behavioral Healthcare Center
Practice address
19056 Greenbush Rd
Parksley, VA 23421
Phone
(757) 665-1260
Fax
(757) 665-4184
NPI assigned
Oct 13, 2006
Last updated
Nov 5, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Authorized official

Name
Mr. James A Cannon
Title
Executive Director
Phone
(757) 442-3636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

19056 Greenbush Rd
Parksley, VA 23421

Mailing address

PO Box 453
Nassawadox, VA 23413-0453
Phone (757) 442-3636

Other names 1

  • Eastern Shore Behavioral Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070521000579 VA Part B Supplier - Clinic/Group Practice 8729185095 Receives reassigned benefits from 26 practitioners
Practice locations: Nassawadox, VA; Parksley, VA

National Provider Directory

National Provider Directory
Tax ID family
Eastern Shore Behavioral Healthcare Center2 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.

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194220800000",
    "number": "1154411510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 453",
            "city": "NASSAWADOX",
            "state": "VA",
            "postal_code": "234130453",
            "telephone_number": "757-442-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19056 GREENBUSH RD",
            "city": "PARKSLEY",
            "state": "VA",
            "postal_code": "23421",
            "telephone_number": "757-665-1260",
            "fax_number": "757-665-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE COMMUNITY MH MR SAS SERVICES BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-11-05",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "757-442-3636",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastern Shore Behavioral Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Parksley, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; 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.