Healthcare Provider Details

I. General information

NPI: 1770501629
Provider Name (Legal Business Name): COMMUNITY FUTURES FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 ARBORETUM PKWY STE 100
NORTH CHESTERFIELD VA
23236-5404
US

IV. Provider business mailing address

9211 ARBORETUM PKWY STE 100
NORTH CHESTERFIELD VA
23236-5404
US

V. Phone/Fax

Practice location:
  • Phone: 804-386-0925
  • Fax: 804-441-9087
Mailing address:
  • Phone: 804-386-0925
  • Fax: 804-441-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number010136199
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON YOUNG
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 804-386-0925