1962653436 NPI number — COMMUNITY DIRECT SERVICES, INC.

Table of content: (NPI 1962653436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962653436 NPI number — COMMUNITY DIRECT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY DIRECT SERVICES, INC.
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:
COMMUNITY DIRECT SERVICES
Provider Other Organization Name Type Code:
4
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:
1962653436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 N CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502-4007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-575-7303
Provider Business Mailing Address Fax Number:
757-226-0578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 BUSINESS PARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-964-4899
Provider Business Practice Location Address Fax Number:
757-965-4359
Provider Enumeration Date:
10/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOMAX
Authorized Official First Name:
CAREY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
757-965-4899

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  593-03-011 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X , with the licence number: 593-03-011 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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