Organization · Type 2 NPI
Western Tidewater Community Services Board
Intellectual Disabilities Intermediate Care Facility · Suffolk, VA
NPI number
1689928996
Active
Practice location
4373 Pruden Boulevard
Suffolk, VA 23434
Fax (757) 255-7139
Mailing address
7025 Harbour View Blvd Ste 119
Suffolk, VA 23435-2762
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual Disabilities Intermediate Care Facility Primary | 315P00000X | 08401005 (VA) |
Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.
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About NPI 1689928996
Western Tidewater Community Services Board's National Provider Identifier is 1689928996, issued on Nov 8, 2012. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Suffolk, VA. The record was last updated on Jan 29, 2024.