Healthcare Provider Details

I. General information

NPI: 1609260306
Provider Name (Legal Business Name): ABRAHAM YOUTH & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 W MAIN ST
RICHMOND VA
23220-4629
US

IV. Provider business mailing address

1510 WILLOW LAWN DR
RICHMOND VA
23230-3429
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-9204
  • Fax: 804-282-0040
Mailing address:
  • Phone: 804-675-9204
  • Fax: 804-282-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberT67148173
License Number StateVA

VIII. Authorized Official

Name: MR. ANCELL SHAW HAMLIN
Title or Position: CEO
Credential:
Phone: 804-955-8699