Provider Demographics
NPI:1427150630
Name:THE CHARLESTON CENTER, INC
Entity type:Organization
Organization Name:THE CHARLESTON CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MANTHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:434-979-8628
Mailing Address - Street 1:1102 ROSE HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5128
Mailing Address - Country:US
Mailing Address - Phone:434-979-8628
Mailing Address - Fax:434-979-8536
Practice Address - Street 1:1102 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5128
Practice Address - Country:US
Practice Address - Phone:434-979-8628
Practice Address - Fax:434-979-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 235Z00000X, 252Y00000X, 261QP2000X
N/A261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA191481OtherANTHEM SLP
VA250964OtherSOUTHERN HEALTH
VA4980671OtherVIRGINIA PREMIER
VA191482OtherANTHEM OT
VA41486OtherOPTIMA
VA276503OtherANTHEM PT
VA4980671Medicaid
VA250964OtherSOUTHERN HEALTH