NPI 1053706812

Providence Community Service LLC

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Chesterfield, VA

Practice location

Address: 7011 Egan Pl, Chesterfield, VA 23832-8310
Phone: (804) 674-1044
Fax: (804) 674-1110

Authorised official

Name: John Thomas Edwards
Title: C.E.O
Phone: (804) 674-1044

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X Licence 225301001 (VA)

Other Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Virginia →

Registry record

NPI: 1053706812
Entity type: Organization
NPI issued: 30 Mar 2015
Record last updated: 30 Mar 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.