NPIMap

Organization Active NPI

City of Virginia Beach Human Services

Doing business as Indian River Icf/Iid

  • Mental Illness Intermediate Care Facility
  • Virginia Beach, VA
National Provider Identifier
1639513781
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
26101001 Issued in VA
Legal business name
CITY OF VIRGINIA BEACH HUMAN SERVICES
Doing business as
Indian River Icf/Iid
Practice address
2525 Lifetime Cir
Virginia Beach, VA 23456-1499
Phone
(757) 385-5575
Fax
(757) 416-5083
NPI assigned
Apr 19, 2013
Last updated
Apr 18, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CITY OF VIRGINIA BEACHAs reported in NPPES

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
Mental Illness Intermediate Care Facility 310500000X 26101001 VA Primary

Addresses

Primary practice location

2525 Lifetime Cir
Virginia Beach, VA 23456-1499

Mailing address

3432 Virginia Beach Blvd
Virginia Beach, VA 23452-4420
Phone (757) 385-0687

Other names 1

  • INDIAN RIVER ICF/IID Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639513781. Details of each certification follow.

  • CCN 49G060 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 49G060

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
INDIAN RIVER RESIDENCE - A
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 29, 2013
Last certification
Jul 7, 2023
Beds
5
Ownership / control type
City/Town
Facility address
2525 Lifetime Circle
Virginia Beach, VA 23456

National Provider Directory

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

Other organizations with this tax ID 8

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

Locations

2525 Lifetime Cir
Virginia Beach, VA 23456
Phone (757) 385-5575

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1366329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1639513781",
    "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",
            "telephone_number": "757-385-0687",
            "fax_number": "757-306-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 LIFETIME CIR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234561499",
            "telephone_number": "757-385-5575",
            "fax_number": "757-416-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF VIRGINIA BEACH HUMAN SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CITY OF VIRGINIA BEACH",
        "enumeration_date": "2013-04-19",
        "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": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "VA",
            "license": "26101001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INDIAN RIVER ICF/IID",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "INDIAN RIVER ICF/IID",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.