Williamsville Wellness PHP

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

License

994 Issued in VA

Legal business name

WILLIAMSVILLE WELLNESS PHP

Practice address

10515 Cabaniss LN
Hanover, VA 23069-1840

Phone

(804) 559-9959

Fax

(804) 559-9613

NPI assigned

Oct 23, 2015

Last updated

Oct 23, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

WILLIAMSVILLE WELLNESS, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Robert Woodrow Cabaniss Jr.

Title

Executive Director

Phone

(804) 559-9959

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Williamsville Wellness Center Other name

Part of

Williamsville Wellness LLC

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.

• Peter B Breslin, M.D.

  • Psychiatry Physician
  • Glen Allen, VA
  • NPI 1114288529
  NPD (past)

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

{
    "created_epoch": "1445558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445558400000",
    "number": "1871965301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10515 CABANISS LN",
            "city": "HANOVER",
            "state": "VA",
            "postal_code": "230691840",
            "telephone_number": "804-559-9959",
            "fax_number": "804-559-9613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10515 CABANISS LN",
            "city": "HANOVER",
            "state": "VA",
            "postal_code": "230691840",
            "telephone_number": "804-559-9959",
            "fax_number": "804-559-9613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSVILLE WELLNESS PHP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAMSVILLE WELLNESS, LLC",
        "enumeration_date": "2015-10-23",
        "last_updated": "2015-10-23",
        "status": "A",
        "authorized_official_last_name": "CABANISS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "WOODROW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-559-9959",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "VA",
            "license": "994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI WILLIAMSVILLE WELLNESS IOP",
            "identifier": "1376941203",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1477704708",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamsville Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Todd Charles Stonnell, LPC, ATR-BC
• Nina Sullivan, NP
• Lindsey Swietnicki, LPC
• William Kenneth Trimble, CRNA
• Williamsville Wellness LLC (Williamsville Wellness Center)

• Psychiatric Residential Treatment Facility in Hanover, VA
• Providers in Hanover, VA by specialty
• Psychiatric Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.