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ST MARYS HOME FOR DISABLED CHILDREN

Intermediate Care Mentally Retarded

Norfolk, Virginia

Provider NPI: 1740217918

Organization Information:
Organization Name:  ST MARYS HOME FOR DISABLED CHILDREN
Organization is not Subpart
Authorized Official:  WILLIAM C GIERMAK  CEO  757-6222208

Practice Location:
6171 KEMPSVILLE CIRCLE  NORFOLK, VA 23502 US
Tel: 757-622-2208  Fax: 757-640-0147

Business Mailing Address:
6171 KEMPSVILLE CIRCLE  NORFOLK, VA 23502 US
Tel: 757-622-2208  Fax: 757-640-0147

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
VA30414001

Other Provider Identifiers:

IssuerNumberStateType
004966333VA05
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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