NPI 1689928996

Western Tidewater Community Services Board

Organisation Intellectual Disabilities Intermediate Care Facility Suffolk, VA

Practice location

Address: 4373 Pruden Boulevard, Suffolk, VA 23434
Phone: (757) 255-7127
Fax: (757) 255-7139
Mailing address: 7025 Harbour View Blvd STE 119, Suffolk, VA 23435-2762

Authorised official

Name: Demetrios Peratsakis
Title: Executive Director
Phone: (757) 255-7133

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 08401005 (VA)

Other Intermediate Care Facility, Intellectual Disabilities providers in Virginia →

Registry record

NPI: 1689928996
Entity type: Organization
NPI issued: 8 Nov 2012
Record last updated: 29 Jan 2024

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.