WESTERN TIDEWATER COMMUNITY SERVICES BOARD NPI 1689928996

NPI Information

NPI: 1689928996
Provider Name: WESTERN TIDEWATER COMMUNITY SERVICES BOARD

Other Name: VINCE'S PLACE/CHASE'S WAY ICF/IID

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
4373 PRUDEN BOULEVARD
SUFFOLK, VA
ZIP 23434
Phone: (757) 255-7127
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WESTERN TIDEWATER COMMUNITY SERVICES BOARD is an intermediate care facility mentally retarded in Suffolk, VA. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. WESTERN TIDEWATER COMMUNITY SERVICES BOARD NPI is 1689928996. The provider is registered as an organization entity type.
The provider Other Name Is Vince's Place/chase's Way Icf/iid.

The provider's business location address is:

4373 PRUDEN BOULEVARD
SUFFOLK, VA
ZIP 23434
Phone: (757) 255-7127
Fax: (757) 255-7139

The provider's authorized official is Demetrios Peratsakis .
The authorized official title is Executive Director and has the following contact phone number (757) 255-7133.

The enumeration date for this NPI number is 11/8/2012 and was last updated on 1/29/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		08401005	VIRGINIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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