Organization
EASTERN STATE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN M FAVRET (HOSPITAL DIRECTOR)
(757) 253-5241
Entity
Organization
Contact information
Practice address
4601 IRONBOUND RD, WILLIAMSBURG, VA 23188-2648
(757) 253-4309
(757) 253-4625
Mailing address
4601 IRONBOUND RD, WILLIAMSBURG, VA 23188-2648
(757) 253-4309
(757) 253-4625
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
0101049272
VA
Other
Enumeration date
02/04/2010
Last updated
02/04/2010
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