NPIMap

Organization Active NPI

City of Virginia Beach Human Services

  • Intellectual Disabilities Intermediate Care Facility
  • Virginia Beach, VA
National Provider Identifier
1407917347
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
261-01-001 Issued in VA
Legal business name
CITY OF VIRGINIA BEACH HUMAN SERVICES
Practice address
145 S Kentucky Ave
Virginia Beach, VA 23452-2382
Phone
(757) 437-6275
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2022

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

Authorized official

Name
Margaret G Bailey
Title
Reimbursement Manager
Phone
(757) 385-0687

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 261-01-001 VA Primary

Addresses

Primary practice location

145 S Kentucky Ave
Virginia Beach, VA 23452-2382

Mailing address

3432 Virginia Beach Blvd
Virginia Beach, VA 23452-4420

Other identifiers 1

IdentifierTypeStateIssuer
004960459MedicaidVA

Other names 1

  • Kentucky Ave ICF MR Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 49G026

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
KENTUCKY AVENUE RESIDENCE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 20, 2002
Last certification
Sep 21, 2022
Beds
8
Ownership / control type
City/Town
Most recent change of ownership
Apr 29, 2004
Facility address
145 Kentucky Avenue
Virginia Beach, VA 23452

National Provider Directory

National Provider Directory
Tax ID family
City of Virginia Beach9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1407917347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3432 VIRGINIA BEACH BLVD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234524420",
            "fax_number": "757-306-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 S KENTUCKY AVE",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234522382",
            "telephone_number": "757-437-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF VIRGINIA BEACH HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "REIMBURSEMENT MANAGER",
        "authorized_official_telephone_number": "757-385-0687"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "VA",
            "license": "261-01-001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004960459",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kentucky Ave ICF MR",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Kentucky Ave ICF MR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.