Healthcare Provider Details

I. General information

NPI: 1629484514
Provider Name (Legal Business Name): CHESTERFIELD COMMUNITY SERVICES BOARD-ICF MR GALLOWAY PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 LUCY CORR CT
CHESTERFIELD VA
23832-6657
US

IV. Provider business mailing address

6801 LUCY CORR CT
CHESTERFIELD VA
23832-6657
US

V. Phone/Fax

Practice location:
  • Phone: 804-748-1227
  • Fax: 804-717-6659
Mailing address:
  • Phone: 804-748-1227
  • Fax: 804-717-6659

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: MS. DEBORAH BURCHAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-768-7220