MBHS OF KENBRIDGE, LLC (KENBRIDGE YOUTH ACADEMY) - NPI NUMBER 1972940880

Summary

Provider Name: MBHS OF KENBRIDGE, LLC (KENBRIDGE YOUTH ACADEMY)

NPI Number: 1972940880

Clasification: Clinic/Center (261QM0855X)

Specialization: Adolescent and Children Mental Health

Address:
231 HICKORY RD
KENBRIDGE, VA
ZIP 23944

Phone Number: (454) 676-1378



Detailed Information

MBHS OF KENBRIDGE, LLC is an adolescent and children mental health clinic/center in Kenbridge, VA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. The assigned NPI number for this provider is 1972940880 and is registered as an organization entity type.
The provider Is Doing Business As Kenbridge Youth Academy.

The provider's business address is:

231 HICKORY RD
KENBRIDGE, VA
ZIP 23944-503
Phone: (454) 676-1378

The provider's authorized official is Patricia Hamilton .
The authorized official title is Chief Administrative Officer and has the following contact phone number (454) 676-1378.

The enumeration date for this NPI number is 5/31/2013 and was last updated on 6/6/2013.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QM0855X Clinic/Center Adolescent and Children Mental Health 2139 VA No
2 322D00000X Residential Treatment Facility, Emotionally Disturbed Children 2136-14-001 VA Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1972940880 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name MBHS OF KENBRIDGE, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name KENBRIDGE YOUTH ACADEMY Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 231 HICKORY RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name KENBRIDGE The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name VA The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 239443503 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 4546761378 The telephone number associated with the location address of the provider being identified.
13 Provider Enumeration Date 5/31/2013 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 6/6/2013 The date that a record was last updated or changed.
15 Authorized Official Last Name HAMILTON The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name PATRICIA The first name of the authorized official.
17 Authorized Official Title or Position CHIEF ADMINISTRATIVE OFFICER The title or position of the authorized official.
18 Authorized Official Telephone Number 4546761378 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 261QM0855X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Provider License Number 1 2139 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
21 Provider License Number State Code 1 VA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 322D00000X
24 Provider License Number 2 2136-14-001 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
25 Provider License Number State Code 2 VA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
26 Healthcare Provider Primary Taxonomy Switch 2 Y
27 Is Organization Subpart Y
28 Parent Organization LBN MERIDIAN BEHAVIORAL HEALTH SYSTEMS
29 Parent Organization TIN

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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