Healthcare Provider Details

I. General information

NPI: 1962872663
Provider Name (Legal Business Name): VIRGINIA TECH ADULT DAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WALLACE HALL (0416)
BLACKBURG VA
24061
US

IV. Provider business mailing address

102 WALLACE HALL (0416)
BLACKBURG VA
24061
US

V. Phone/Fax

Practice location:
  • Phone: 540-231-3161
  • Fax: 540-231-8786
Mailing address:
  • Phone: 540-231-3161
  • Fax: 540-231-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC786701
License Number StateVA

VIII. Authorized Official

Name: ILA W SCHEPISI
Title or Position: DIRECTOR
Credential:
Phone: 540-231-3161