Healthcare Provider Details

I. General information

NPI: 1962466706
Provider Name (Legal Business Name): ST. JOSEPH'S VILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 BROOK ROAD
RICHMOND VA
23227-1338
US

IV. Provider business mailing address

8000 BROOK ROAD
RICHMOND VA
23227-1338
US

V. Phone/Fax

Practice location:
  • Phone: 804-553-3200
  • Fax: 804-553-3259
Mailing address:
  • Phone: 804-553-3200
  • Fax: 804-553-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number160
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number160
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number160
License Number StateVA

VIII. Authorized Official

Name: MS. CYNTHIA LYNN FAISON
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 804-553-3249