1821239120 NPI number — CLINICAL SERVICES OF VIRGINIA, LLC

Table of content: (NPI 1821239120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821239120 NPI number — CLINICAL SERVICES OF VIRGINIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL SERVICES OF VIRGINIA, 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:
1821239120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7206 HULL STREET RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-5827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-562-3317
Provider Business Mailing Address Fax Number:
804-562-0561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7206 HULL STREET RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235-5827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-562-3317
Provider Business Practice Location Address Fax Number:
804-562-0561
Provider Enumeration Date:
03/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SALES
Authorized Official First Name:
BURNETTE
Authorized Official Middle Name:
SEWARD
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
804-562-3317

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1257 , 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)

  • Identifier: 1257 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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