1629158159 NPI number — CHILD & FAMILY SERVICES OF EASTERN VIRGINIA, INC

Table of content: (NPI 1629158159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629158159 NPI number — CHILD & FAMILY SERVICES OF EASTERN VIRGINIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILD & FAMILY SERVICES OF EASTERN VIRGINIA, 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:
Provider Other Organization Name Type Code:
6
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:
1629158159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W 19TH ST
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:
23517-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-622-7017
Provider Business Mailing Address Fax Number:
757-640-8402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23517-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-622-7017
Provider Business Practice Location Address Fax Number:
757-640-8402
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
LUVERNE
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
757-622-7017

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1538364179 . This is a "MARY A BRANTLEY - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1295888501 . This is a "KRISTIN HARDEE-POULIN - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1689689234 . This is a "FREDRICK D WESTON - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1285737205 . This is a "GLORIA M SAUNDERS - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417028291 . This is a "CONSTANTINA KOUZI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1215917315 . This is a "JAMES ZELL - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1033273560 . This is a "J. KELLIE EVANS - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1194891598 . This is a "ANDREA LONG - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1487764825 . This is a "DEBORAH LEECY - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1487840641 . This is a "SHAWN WARE-AVANT - PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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