Healthcare Provider Details

I. General information

NPI: 1013464361
Provider Name (Legal Business Name): SACIENT ACP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2016
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 DAKOTA AVE
RICHMOND VA
23220-6911
US

IV. Provider business mailing address

PO BOX 28684
HENRICO VA
23228-8684
US

V. Phone/Fax

Practice location:
  • Phone: 804-418-0876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003315
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: IVAN TOLBERT
Title or Position: CEO
Credential:
Phone: 804-418-0876