Provider Demographics
NPI:1861595357
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-966-9640
Mailing Address - Street 1:12025 COURTHOUSE RD
Mailing Address - Street 2:P.O. BOX 86
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124
Mailing Address - Country:US
Mailing Address - Phone:804-966-9640
Mailing Address - Fax:804-966-5210
Practice Address - Street 1:12025 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124
Practice Address - Country:US
Practice Address - Phone:804-966-9640
Practice Address - Fax:804-966-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare