Healthcare Provider Details

I. General information

NPI: 1740586106
Provider Name (Legal Business Name): THE FAISON CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 MARKEL RD
RICHMOND VA
23230-3008
US

IV. Provider business mailing address

5311 MARKEL RD
RICHMOND VA
23230-3008
US

V. Phone/Fax

Practice location:
  • Phone: 804-612-1947
  • Fax: 804-612-1955
Mailing address:
  • Phone: 804-612-1947
  • Fax: 804-612-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number1726-07-010
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1726-02-010
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1726-07-010
License Number StateVA

VIII. Authorized Official

Name: JESSICA SHADE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 804-612-1947