1255500021 NPI number — COMMUNITY ALTERNATIVES OF VIRGINIA

Table of content: (NPI 1255500021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255500021 NPI number — COMMUNITY ALTERNATIVES OF VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ALTERNATIVES OF VIRGINIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GIRLS IN FOCUS OF VIRGINIA
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255500021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N WHITTINGTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-5186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-866-0860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4807 BURNHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23234-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-615-4083
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PANK
Authorized Official First Name:
MARY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PARALEGAL
Authorized Official Telephone Number:
502-394-2100

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010291402 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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