Provider Demographics
NPI:1497856090
Name:REGION TEN COMMUNITY COMMUNITY SERVICES BOARD
Entity type:Organization
Organization Name:REGION TEN COMMUNITY COMMUNITY SERVICES BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTACT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-972-1800
Mailing Address - Street 1:800 PRESTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4420
Mailing Address - Country:US
Mailing Address - Phone:434-972-1788
Mailing Address - Fax:434-970-2158
Practice Address - Street 1:800 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4420
Practice Address - Country:US
Practice Address - Phone:434-972-1788
Practice Address - Fax:434-970-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945018Medicaid
VA4945018Medicaid