| Organization Name: | CRATER CHILD DEVELOPMENT CLINIC |
| NPI Number: | 1164468823 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL OWEN ROYSTER (DISTRICT HEALTH DIRECTOR) |
| Mailing Address: | 2002 Wakefield Street Petersburg |
| State: | VA US |
| Postal Code: | 238052112 |
| Phone Number: | 8048626186 |
| Fax Number: | 8048626276 |
| NPI Enumeration Date: | 06/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |