Provider Demographics
NPI:1972940880
Name:MBHS OF KENBRIDGE, LLC
Entity type:Organization
Organization Name:MBHS OF KENBRIDGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:454-676-1378
Mailing Address - Street 1:231 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:KENBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:23944-3503
Mailing Address - Country:US
Mailing Address - Phone:454-676-1378
Mailing Address - Fax:
Practice Address - Street 1:231 HICKORY RD
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944-3503
Practice Address - Country:US
Practice Address - Phone:454-676-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN BEHAVIORAL HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-31
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2139261QM0855X
VA2136-14-001322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health