Healthcare Provider Details

I. General information

NPI: 1043131394
Provider Name (Legal Business Name): COMMUNITY COALITION OF SUSSEX VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9436 MAYES STREET
JARRATT VA
23867
US

IV. Provider business mailing address

9436 MAYES STREET
JARRATT VA
23867
US

V. Phone/Fax

Practice location:
  • Phone: 804-255-9680
  • Fax:
Mailing address:
  • Phone: 804-255-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT E. HAMLIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 540-798-0036