Provider Demographics
NPI:1699754010
Name:PIEDMONT REGIONAL COMMUNITY SERVICES BOARD
Entity type:Organization
Organization Name:PIEDMONT REGIONAL COMMUNITY SERVICES BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-632-7128
Mailing Address - Street 1:24 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2810
Mailing Address - Country:US
Mailing Address - Phone:276-632-7128
Mailing Address - Fax:276-632-0127
Practice Address - Street 1:24 CLAY ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2810
Practice Address - Country:US
Practice Address - Phone:276-632-7128
Practice Address - Fax:276-632-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 253Z00000X
VA038251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945221Medicaid
1699754010OtherNPI
C04131Medicare ID - Type Unspecified
VAC03162Medicare PIN