Organization Name: | WESTERN TIDEWATER COMMUNITY SERVICES BOARD |
NPI Number: | 1386687549 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEMETRIOS PERATSAKIS (EXECUTIVE DIRECTOR) |
Mailing Address: | 404 Finney Ave Suffolk |
State: | VA US |
Postal Code: | 234343852 |
Phone Number: | 7572557127 |
Fax Number: | |
NPI Enumeration Date: | 06/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 084-01-001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |