NPIMap

Organization Active NPI

Chesterfield Community Services Board-Icf Mr Galloway Place

  • Intellectual Disabilities Intermediate Care Facility
  • Chesterfield, VA
National Provider Identifier
1629484514
Registry record updated Jul 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
CHESTERFIELD COMMUNITY SERVICES BOARD-ICF MR GALLOWAY PLACE
Practice address
6801 Lucy Corr CT
Chesterfield, VA 23832-6657
Phone
(804) 748-1227
Fax
(804) 717-6659
NPI assigned
Jul 11, 2014
Last updated
Jul 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2014

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

Authorized official

Name
Ms. Deborah Burcham
Title
Executive Director
Phone
(804) 768-7220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

6801 Lucy Corr CT
Chesterfield, VA 23832-6657

Mailing address

6801 Lucy Corr CT
Chesterfield, VA 23832-6657
Phone (804) 748-1227

Other identifiers 1

IdentifierTypeStateIssuer
004945352MedicaidVA

National Provider Directory

National Provider Directory
Tax ID family
Chesterfield County Mental Health9 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.

Locations

6801 Lucy Corr Ct
Chesterfield, VA 23832
Phone (804) 748-1227

Practitioners & affiliated clinicians

Practitioners 1

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": "1405036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405036800000",
    "number": "1629484514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 LUCY CORR CT",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238326657",
            "telephone_number": "804-748-1227",
            "fax_number": "804-717-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 LUCY CORR CT",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238326657",
            "telephone_number": "804-748-1227",
            "fax_number": "804-717-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTERFIELD COMMUNITY SERVICES BOARD-ICF MR GALLOWAY PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-11",
        "last_updated": "2014-07-11",
        "status": "A",
        "authorized_official_last_name": "BURCHAM",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-768-7220",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945352",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.