Healthcare Provider Details

I. General information

NPI: 1457505943
Provider Name (Legal Business Name): F.A.C.E.S. COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 BURROWIN DR
CHESAPEAKE VA
23321-1878
US

IV. Provider business mailing address

1519 BURROWIN DR
CHESAPEAKE VA
23321-1878
US

V. Phone/Fax

Practice location:
  • Phone: 757-478-8814
  • Fax: 757-465-8093
Mailing address:
  • Phone: 757-478-8814
  • Fax: 757-465-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADRIANNE SEARS
Title or Position: CHIEF ADMINISTRATIONS OFFICER
Credential:
Phone: 757-478-8814