MEDICARE: MR. JOSEPH DEE MORRISSEY

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	524-01-001	VA

General Provider Information

NPI Number	:	1396927422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH DEE MORRISSEY

Provider Business Mailing Address
First Line	:	8700 OSBORNE TPKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-8104
Country	:	US
Telephone Number	:	804-795-2249
Fax Number	:	804-674-1688

Provider Business Practice Location Address
First Line	:	8700 OSBORNE TPKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-8104
Country	:	US
Telephone Number	:	804-795-2249
Fax Number	:	804-674-1688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	11/30/2007

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