1083620744 NPI number — VELDOT RESIDENTIAL SERVICES, LLC

Table of content: RIFKIE RITA BERGMAN LCSW (NPI 1154753192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083620744 NPI number — VELDOT RESIDENTIAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VELDOT RESIDENTIAL SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083620744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 LAURELWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23234-3220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-675-7072
Provider Business Mailing Address Fax Number:
804-675-0469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 LAURELWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23234-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-675-7072
Provider Business Practice Location Address Fax Number:
804-675-0469
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
ALEAVELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
804-675-7072

Provider Taxonomy Codes

  • Taxonomy code: 385HR2060X , with the licence number:  579 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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