Healthcare Provider Details

I. General information

NPI: 1972738516
Provider Name (Legal Business Name): TIKOR COMMUNITY & HUMAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 NEWINGTON WOODS DR
SPRINGFIELD VA
22153-2235
US

IV. Provider business mailing address

7810 NEWINGTON WOODS DR
SPRINGFIELD VA
22153-2235
US

V. Phone/Fax

Practice location:
  • Phone: 703-596-4830
  • Fax: 703-652-7737
Mailing address:
  • Phone: 703-596-4830
  • Fax: 703-652-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1245-01-001
License Number StateVA

VIII. Authorized Official

Name: MR. MICHAEL JOSEPH SAFFA-WUYA SR.
Title or Position: PRESIDENT
Credential: MBA
Phone: 703-596-4830