NPIMap

Organization Active NPI

Sanctyouary

  • Clinical Social Worker
  • Virginia Beach, VA
National Provider Identifier
1588440119
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SANCTYOUARY
Practice address
900 Commonwealth PL Ste 2001020
Virginia Beach, VA 23464-4517
Phone
(757) 749-8507
NPI assigned
Sep 8, 2023
Last updated
Oct 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Keimishia Holloway, RNNPI 1932931516
Title
Registerd Nurse
Phone
(757) 749-8507

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X NU
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

900 Commonwealth PL Ste 2001020
Virginia Beach, VA 23464-4517

Mailing address

900 Commonwealth PL Ste 2001020
Virginia Beach, VA 23464-4517
Phone (757) 749-8507

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240605003030 VA Part B Supplier - Clinic/Group Practice 8022550011 Receives reassigned benefits from 5 practitioners
Practice locations: Virginia Beach, VA

National Provider Directory

National Provider Directory

Locations

900 Commonwealth Pl
Ste 2001020
Virginia Beach, VA 23464
Phone (757) 749-8507

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1694131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1588440119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 COMMONWEALTH PL STE 2001020",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234644517",
            "telephone_number": "757-749-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 COMMONWEALTH PL STE 2001020",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234644517",
            "telephone_number": "757-749-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANCTYOUARY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-08",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "HOLLOWAY",
        "authorized_official_first_name": "KEIMISHIA",
        "authorized_official_title_or_position": "REGISTERD NURSE",
        "authorized_official_telephone_number": "757-749-8507",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.