Healthcare Provider Details

I. General information

NPI: 1770541161
Provider Name (Legal Business Name): SOUTHEASTERN VIRGINIA TRAINING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STEPPINGSTONE SQUARE
CHESAPEAKE VA
23320-2591
US

IV. Provider business mailing address

2100 STEPPINGSTONE SQUARE
CHESAPEAKE VA
23320-2591
US

V. Phone/Fax

Practice location:
  • Phone: 757-424-8201
  • Fax: 757-424-8348
Mailing address:
  • Phone: 757-424-8201
  • Fax: 757-424-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER FISHER
Title or Position: FACILITY DIRECTOR
Credential: RN, BSN, MPA
Phone: 757-424-8379