Provider Demographics
NPI:1073650099
Name:CITY OF CHESAPEAKE
Entity type:Organization
Organization Name:CITY OF CHESAPEAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANLANDINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MBA
Authorized Official - Phone:757-547-9334
Mailing Address - Street 1:224 GREAT BRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3904
Mailing Address - Country:US
Mailing Address - Phone:757-547-9334
Mailing Address - Fax:757-819-6292
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:CHESAPEAKE COMMUNITY SERVICES BOARD
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-547-9334
Practice Address - Fax:757-819-6292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CHESAPEAKE TA CHESAPEAKE COMMUNITY SERV. BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA141252Y00000X
VA141 16 001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAIG007273OtherMAGELLEAN AGENCY NUMBER
VA1073650099Medicaid
VA083100OtherSENTARA/OPTIMA
VAIG007273OtherFEDERAL HEALTH NET
VA250277OtherANTHEM TRIGON
VAC02889Medicare PIN
VA260002638Medicare PIN