Organization
COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVI
Active
Parent organization
COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AN
Other names
Eastern State Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AN
Authorized official
MR. JACK L. WOOD NHA (HOSPITAL DIRECTOR)
(757) 253-5241
Entity
Organization
Contact information
Practice address
4601 IRONBOUND RD, WILLIAMSBURG, VA 23188-2652
(757) 253-5241
(757) 253-5065
Mailing address
4601 IRONBOUND RD, WILLIAMSBURG, VA 23188-2652
(757) 253-5241
(757) 253-5065
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004901096
—
VA
01
—
007814
ANTHEM BC 423
VA
Enumeration date
09/25/2006
Last updated
06/06/2011
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