NPIMap

Organization Active NPI

Middle Peninsula-Northern Neck Mental Health and Mental Retardation

Doing business as Rural Infant Services Program

  • Speech-Language Pathologist
  • Urbanna, VA
National Provider Identifier
1992879282
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2202002885 Issued in VA
Legal business name
MIDDLE PENINSULA-NORTHERN NECK MENTAL HEALTH AND MENTAL RETARDATION
Doing business as
Rural Infant Services Program
Practice address
5372B Old Virginia Street
Urbanna, VA 23175
Phone
(804) 758-5250
Fax
(804) 758-5183
NPI assigned
Nov 20, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. Charles R Walsh, LCSW
Title
Executive Director
Phone
(804) 758-5314

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305006727 VA
Physical Therapist 225100000X 2305002514 VA
Occupational Therapist 225X00000X VA
Speech-Language Pathologist 235Z00000X 2202000605 VA
Speech-Language Pathologist 235Z00000X 2202002885 VA Primary

Addresses

Primary practice location

5372B Old Virginia Street
Urbanna, VA 23175

Mailing address

PO Box 40
Saluda, VA 23149-0040
Phone (804) 758-5250

Other identifiers 1

IdentifierTypeStateIssuer
4978137MedicaidVA

Other names 1

  • Rural Infant Services Program Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130103000289 VA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 1254235989 Practice locations: Urbanna, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992879282. Details of each certification follow.

  • CCN 496521 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 496521

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
RURAL INFANT SERVICES PROGRAM
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
May 1, 1984
Last certification
Feb 22, 2024
Ownership / control type
Combination Government & Voluntary
Facility address
5372 Old Virginia Street, Suite B
Urbanna, VA 23175

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Mid-Pen-N-N Counsel6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1041 Sharon Rd
Ste 201
King William, VA 23086
Phone (804) 769-2751

5372B Old Virginia St
Urbanna, VA 23175
Phone (804) 758-5250

Practitioners & affiliated clinicians

Practitioners 89

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.

View all 89

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1992879282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "SALUDA",
            "state": "VA",
            "postal_code": "231490040",
            "telephone_number": "804-758-5250",
            "fax_number": "804-758-5138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5372B OLD VIRGINIA STREET",
            "city": "URBANNA",
            "state": "VA",
            "postal_code": "23175",
            "telephone_number": "804-758-5250",
            "fax_number": "804-758-5183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLE PENINSULA-NORTHERN NECK MENTAL HEALTH AND MENTAL RETARDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-758-5314",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305006727",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305002514",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202000605",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202002885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4978137",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Infant Services Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Urbanna, VA

Sources for this page

Verify at the official NPI Registry.