Healthcare Provider Details

I. General information

NPI: 1962653436
Provider Name (Legal Business Name): COMMUNITY DIRECT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 BUSINESS PARK DRIVE SUITE 125
VIRGINIA BEACH VA
23462
US

IV. Provider business mailing address

420 N CENTER DR
NORFOLK VA
23502-4007
US

V. Phone/Fax

Practice location:
  • Phone: 757-964-4899
  • Fax: 757-965-4359
Mailing address:
  • Phone: 757-575-7303
  • Fax: 757-226-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number593-03-011
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number593-03-011
License Number StateVA

VIII. Authorized Official

Name: CAREY L LOMAX
Title or Position: CEO
Credential:
Phone: 757-965-4899