Healthcare Provider Details

I. General information

NPI: 1013306117
Provider Name (Legal Business Name): RCG STATE GOVERNMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 POST OFFICE RD UNIT 4563
MIDLOTHIAN VA
23112-0923
US

IV. Provider business mailing address

1905 HUGUENOT RD SUITE 305
NORTH CHESTERFIELD VA
23235-4312
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-1797
  • Fax: 888-857-8088
Mailing address:
  • Phone: 804-897-1797
  • Fax: 888-857-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SHERMAN ALEXANDER ADKINS JR.
Title or Position: DIRECTOR OF OPERATIONS & FINANCE
Credential:
Phone: 804-491-9543