Healthcare Provider Details

I. General information

NPI: 1629351689
Provider Name (Legal Business Name): BEHAVIOR INTERVENTION OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 TURNER RD
NORTH CHESTERFIELD VA
23225-6415
US

IV. Provider business mailing address

211 TURNER RD
NORTH CHESTERFIELD VA
23225-6415
US

V. Phone/Fax

Practice location:
  • Phone: 804-937-1941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. M GRACE ILORI
Title or Position: DIRECTOR
Credential:
Phone: 804-937-1941