NPI 1265851836

Commonwealth Care Services LLC

Organisation Exclusive Provider Organization Petersburg, VA

Practice location

Address: 444 Pine Ridge Rd, Petersburg, VA 23805-1320
Phone: (804) 919-1126

Authorised official

Name: Jovat C Bates
Title: Owner
Phone: (804) 919-1126

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 2059-010001 (VA)

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Registry record

NPI: 1265851836
Entity type: Organization
NPI issued: 10 Apr 2014
Record last updated: 10 Apr 2014

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.