Healthcare Provider Details

I. General information

NPI: 1154374296
Provider Name (Legal Business Name): COMMUNITY NEUROLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 ROLLING HILLS DR SUITE 200
RICHMOND VA
23229-5011
US

IV. Provider business mailing address

1601 ROLLING HILLS DR SUITE 200
RICHMOND VA
23229-5011
US

V. Phone/Fax

Practice location:
  • Phone: 804-249-8302
  • Fax: 804-249-8321
Mailing address:
  • Phone: 804-249-8302
  • Fax: 804-249-8321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0102050193
License Number StateVA

VIII. Authorized Official

Name: VERONICA CUNNINGHAM
Title or Position: CEO/PRACTICE ADMINISTRATOR
Credential: R.N., B.S.N.
Phone: 804-249-8302