Healthcare Provider Details

I. General information

NPI: 1245487834
Provider Name (Legal Business Name): VIRGINIA BAPTIST CHILDRENS HOME AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MOUNT VERNON LN
SALEM VA
24153-2700
US

IV. Provider business mailing address

860 MOUNT VERNON LN
SALEM VA
24153-2700
US

V. Phone/Fax

Practice location:
  • Phone: 540-389-5468
  • Fax: 540-389-5570
Mailing address:
  • Phone: 540-389-5468
  • Fax: 540-389-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberSS-06-07
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberCO-6-10
License Number StateVA

VIII. Authorized Official

Name: DR. STEPHEN RICHERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 540-389-5468