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5801 Bremo Rd Richmond VA 23226-1907 | |
| (804) 287-7836 | |
| (804) 281-8557 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 5801 Bremo Rd, Richmond, Virginia |
| Authorized Official Name and Position | Kimberly Ralston (SYSTEM DIRECTOR) |
| Authorized Official Contact | 4199965119 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 639994 Cincinnati OH 45263-9994 Ph: (804) 627-5462 | 5801 Bremo Rd Richmond VA 23226-1907 Ph: (804) 287-7836 |
| NPI Number | 1184687790 |
|---|---|
| Provider Enumeration Date | 04/07/2006 |
| Last Update Date | 09/22/2020 |
| Certification Date | 09/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184687790 | NPI | - | NPPES |
| 4900596 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | H1723 (Virginia) | Primary |
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