Healthcare Provider Details

I. General information

NPI: 1306308762
Provider Name (Legal Business Name): ST. JOSEPH'S VILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 BROOK RD
RICHMOND VA
23227-1338
US

IV. Provider business mailing address

8000 BROOK RD
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 Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RHONDA COUNCIL
Title or Position: COMPLIANCE COORDINATOR
Credential:
Phone: 804-553-3200