MEDICARE: WESTERN TIDEWATER COMMUNITY MENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1164944740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN TIDEWATER COMMUNITY MENTAL

Provider Business Mailing Address
First Line	:	7025 HARBOUR VIEW BLVD STE 119
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-2762
Country	:	US
Telephone Number	:	757-966-2805
Fax Number	:	757-673-2586

Provider Business Practice Location Address
First Line	:	5268 GODWIN BLVD
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8114
Country	:	US
Telephone Number	:	757-255-7117
Fax Number	:	757-255-7139

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	ANDREW F JUREWICZ
Credential	:
Telephone Number	:	757-966-2805

Provider Enumeration Date	:	07/14/2017
Last Update Date	:	03/23/2026

Similar Medicare Providers

1689711046 — LUXOTTICA OF AMERICA INC
Practice Location Address:

4000 LUXOTTICA PL , ATTN MEDICARE DEPT
MASON, OH
45040-8114

Practice Phone: 513-765-3534
Practice Fax:

1205389764 — LUXOTTICA RETAIL NORTH AMERICA INC
Practice Location Address:

4000 LUXOTTICA PL , ATTN: MEDICARE DEPT
MASON, OH
45040-8114

Practice Phone: 513-765-6000
Practice Fax:

1538603709 — LUXOTTICA RETAIL NORTH AMERICA INC.
Practice Location Address:

4000 LUXOTTICA PL , ATTN: MEDICARE DEPARTMENT
MASON, OH
45040-8114

Practice Phone: 513-765-6623
Practice Fax:

1447415716 — MS. PATRICIA RAE THORNES LPC
Practice Location Address:

5268 GODWIN BLVD
SUFFOLK, VA
23434-8114

Practice Phone: 757-255-2662
Practice Fax: 757-255-7115

1750699104 — CRISTINA VANESSA REAMON LCSW
Practice Location Address:

5268 GODWIN BLVD
SUFFOLK, VA
23434-8114

Practice Phone: 757-925-2222
Practice Fax:

1215222716 — MR. DEMETRIOS N PERATSAKIS PD, MS, LPC
Practice Location Address:

5268 GODWIN BLVD
SUFFOLK, VA
23434-8114

Practice Phone: 757-255-7126
Practice Fax:

Directions to “WESTERN TIDEWATER COMMUNITY MENTAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.