Healthcare Provider Details

I. General information

NPI: 1366727984
Provider Name (Legal Business Name): CIVITAS HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5663 S LABURNUM AVE
RICHMOND VA
23231-4418
US

IV. Provider business mailing address

5663 S LABURNUM AVE
RICHMOND VA
23231-4418
US

V. Phone/Fax

Practice location:
  • Phone: 804-737-3917
  • Fax: 804-737-3940
Mailing address:
  • Phone: 804-737-3917
  • Fax: 804-737-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1588
License Number StateVA

VIII. Authorized Official

Name: MR. LEMAR BOWERS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 804-737-3917