NPIMap

Organization Active NPI

Goochland Powhatan Community Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Goochland, VA
National Provider Identifier
1467448571
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
207 Issued in VA
Legal business name
GOOCHLAND POWHATAN COMMUNITY SERVICES
Practice address
3058 River Rd W
Goochland, VA 23063-3202
Phone
(804) 556-5400
Fax
(804) 556-5403
NPI assigned
Sep 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Authorized official

Name
Lester Saltzberg
Title
Executive Director
Phone
(804) 556-5400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 207 VA Primary
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

3058 River Rd W
Goochland, VA 23063-3202

Mailing address

PO Box 189
Goochland, VA 23063-0189
Phone (804) 556-5400

Other identifiers 5

IdentifierTypeStateIssuer
004978561MedicaidVA
004945557MedicaidVA
004949927MedicaidVA
004948262MedicaidVA
004949919MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071101000466 VA Part B Supplier - Clinic/Group Practice 5193812501 Receives reassigned benefits from 15 practitioners
Practice locations: Goochland, VA; Powhatan, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2116099Goochland Powhatan Community Services3058 River Road West, Goochland, VA 23063Certificate of waiverJul 18, 2028

National Provider Directory

National Provider Directory

Locations

3910 Old Buckingham Rd
Ste A
Powhatan, VA 23139

3910 Old Buckingham Rd
Powhatan, VA 23139
Phone (804) 598-2200

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1467448571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "GOOCHLAND",
            "state": "VA",
            "postal_code": "230630189",
            "telephone_number": "804-556-5400",
            "fax_number": "804-556-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3058 RIVER RD W",
            "city": "GOOCHLAND",
            "state": "VA",
            "postal_code": "230633202",
            "telephone_number": "804-556-5400",
            "fax_number": "804-556-5403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOCHLAND POWHATAN COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "SALTZBERG",
        "authorized_official_first_name": "LESTER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-556-5400"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "VA",
            "license": "207",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004978561",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945557",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004949927",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004948262",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004949919",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goochland, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.