Provider Demographics
NPI:1902965882
Name:PSYCHIATRIC CARE CENTER
Entity Type:Organization
Organization Name:PSYCHIATRIC CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PARTHIV
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-643-8989
Mailing Address - Street 1:300 GLEBE SPRING LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3125
Mailing Address - Country:US
Mailing Address - Phone:757-643-8989
Mailing Address - Fax:
Practice Address - Street 1:300 GLEBE SPRING LN
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3125
Practice Address - Country:US
Practice Address - Phone:757-643-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012268722084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA142821OtherANTHEM
VA010086639Medicaid
VAO80759MOtherSENTARA
VA142821OtherANTHEM
VA010086639Medicaid