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CHESTERFIELD COMMUNITY SERVICES BOARD - ICF PINE FOREST

Intermediate Care Mentally Retarded

Chesterfield, Virginia

Provider NPI: 1033397542

Organization Information:
Organization Name:  CHESTERFIELD COMMUNITY SERVICES BOARD - ICF PINE FOREST
Organization is not Subpart
Authorized Official:  KELLY  FRIED  EXECUTIVE DIRECTOR  804-7687227

Practice Location:
6801 LUCY CORR CT  CHESTERFIELD, VA 23832 US
Tel: 804-748-1227  Fax: 804-717-6659

Business Mailing Address:
6801 LUCY CORR CT  CHESTERFIELD, VA 23832 US
Tel: 804-748-1227  Fax: 804-717-6659

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
VA222-17-001

Other Provider Identifiers:

IssuerNumberStateType
PENDINGVA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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