MEDICARE: COMMONWEALTH FAMILY SERVICES, LLC

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	251S00000X	Community/Behavioral Health Agency	1869	VA

General Provider Information

NPI Number	:	1548520539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH FAMILY SERVICES, LLC

Provider Business Mailing Address
First Line	:	11923 CENTRE ST
Second Line	:	SUITE A-7
City	:	CHESTER
State	:	VA
Zip	:	23831-1702
Country	:	US
Telephone Number	:	804-502-3229
Fax Number	:

Provider Business Practice Location Address
First Line	:	11923 CENTRE ST
Second Line	:	SUITEA-7
City	:	CHESTER
State	:	VA
Zip	:	23831-1702
Country	:	US
Telephone Number	:	804-502-3229
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER/EXECUTIVE DIRECTOR
Name	:	SHANTELL J MALACHI
Credential	:	MBA
Telephone Number	:	804-502-3229

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	08/28/2013

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