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800 Shenandoah Avenue Suite 170 Elkton VA 22827 | |
(540) 298-9900 | |
(540) 298-8991 |
Full Name | |
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Speciality | Clinic/Center |
Location | 800 Shenandoah Avenue, Elkton, Virginia |
Authorized Official Name and Position | Lisa Bricker (CEO) |
Authorized Official Contact | 5404334913 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 308 Harrisonburg VA 22803-0308 Ph: (540) 433-4913 | 800 Shenandoah Avenue Suite 170 Elkton VA 22827 Ph: (540) 298-9900 |
NPI Number | 1750827523 |
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Provider Enumeration Date | 01/17/2017 |
Last Update Date | 09/25/2023 |
Medicare PECOS PAC ID | 1759444581 |
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Medicare Enrollment ID | O20170331001284 |
Identifier | Type | State | Issuer |
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1750827523 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Julio Manuel Reyes Flores |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1104504778 PECOS PAC ID: 8426400847 Enrollment ID: I20240122000317 |