Healthcare Provider Details

I. General information

NPI: 1184960908
Provider Name (Legal Business Name): CAPITAL CENTER OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 W LABURNUM AVE
RICHMOND VA
23227-4312
US

IV. Provider business mailing address

PO BOX 4255
RICHMOND VA
23220-8255
US

V. Phone/Fax

Practice location:
  • Phone: 804-359-8821
  • Fax: 804-359-8827
Mailing address:
  • Phone: 804-359-8821
  • Fax: 804-359-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1227158
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1227158
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1227158
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1227158
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number1227158
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number1227158
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number1227158
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1227158
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 10
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1227158
License Number StateVA

VIII. Authorized Official

Name: MR. VICTOR RIDGLEY
Title or Position: BOARD CHAIR
Credential:
Phone: 804-359-8821