NPIMap

Organization Active NPI

District 19 Community Services Board

  • Community/Behavioral Health Agency
  • Petersburg, VA
National Provider Identifier
1225094451
Registry record updated Jul 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
DISTRICT 19 COMMUNITY SERVICES BOARD
Practice address
20 W Bank St
Suite 2
Petersburg, VA 23803-3279
Phone
(804) 862-8054
Fax
(804) 863-1665
NPI assigned
Apr 25, 2006
Last updated
Jul 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2009

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

Authorized official

Name
Mr. Joseph E. Hubbard, C.P.A.
Title
Executive Director
Phone
(804) 862-8054

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Early Intervention Provider Agency 252Y00000X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

20 W Bank St
Suite 2
Petersburg, VA 23803-3279

Mailing address

20 W Bank St
Suite 2
Petersburg, VA 23803-3279
Phone (804) 862-8054

Other identifiers 1

IdentifierTypeStateIssuer
4945280MedicaidVA

Other names 1

  • District 19 Mental Health and Mental Retardation Services Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421001639 VA Part B Supplier - Clinic/Group Practice 4082502398 Receives reassigned benefits from 16 practitioners
Practice locations: Petersburg, VA; Prince George, VA; Emporia, VA; Disputanta, VA; Dinwiddie, VA

National Provider Directory

National Provider Directory
Tax ID family
District 19 Community Services Board2 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

3660 Boulevard
Ste A
Colonial Hgts, VA 23834
Phone (804) 520-7210

13902 Courthouse Rd
Dinwiddie, VA 23841

6102 County Dr
Disputanta, VA 23842

1101 Greensville County Cir
Emporia, VA 23847
Phone (434) 348-8900

215 W Atlantic St
Emporia, VA 23847
Phone (434) 634-5181

111 Morton Ave
Petersburg, VA 23805
Phone (804) 862-8004

20 W Bank St
Ste 1
Petersburg, VA 23803
Phone (804) 862-8003

20 W Bank St
Ste 2
Petersburg, VA 23803
Phone (804) 861-6606

20 W Bank St
Ste 5
Petersburg, VA 23803
Phone (804) 862-6082

20 W Bank St
Ste 6
Petersburg, VA 23803
Phone (804) 835-5425

4910 Prince George Dr
Prince George, VA 23875
Phone (804) 541-8660

6610 Commons Dr
Ste 103
Prince George, VA 23875
Phone (804) 722-0620

Practitioners & affiliated clinicians

Practitioners 64

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 64

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248912000000",
    "number": "1225094451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 W BANK ST",
            "address_2": "SUITE 2",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033279",
            "telephone_number": "804-862-8054",
            "fax_number": "804-863-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 W BANK ST",
            "address_2": "SUITE 2",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033279",
            "telephone_number": "804-862-8054",
            "fax_number": "804-863-1665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTRICT 19 COMMUNITY SERVICES BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2009-07-30",
        "status": "A",
        "authorized_official_last_name": "HUBBARD",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-862-8054",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.P.A."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4945280",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "District 19 Mental Health and Mental Retardation Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2009; 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.