Community S.H.a.R.E., LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1807 Issued in VA

Legal business name

COMMUNITY S.H.A.R.E., LLC

Practice address

762 Independence Blvd Ste 100C
Virginia Beach, VA 23455-6250

Phone

(757) 644-4192

Fax

(757) 644-4196

NPI assigned

Dec 21, 2012

Organization subpart

No

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

Authorized official

Name

Jayson Johnson

Title

Executive Director

Phone

(757) 644-4192

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356048000000",
    "number": "1962748830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 CENTERVILLE TPKE # 117-247",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234646800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 INDEPENDENCE BLVD STE 100C",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556250",
            "telephone_number": "757-644-4192",
            "fax_number": "757-644-4196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY S.H.A.R.E., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-21",
        "last_updated": "2012-12-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JAYSON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "757-644-4192"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "1807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; 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.