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General NPI Number Information
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NPI Number | 1215176565
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Entity Type | Organization
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Legal Business Name | WEST PETERSBURG SENIOR ADULT CENTER
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 25720 GREENSVILLE AVE
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City | PETERSBURG
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State | VA
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Zip | 23803-8604
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Country | US
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Telephone | 804-861-1452
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Fax | 804-861-8642
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Provider Business Mailing Address
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Address Line | 25720 GREENSVILLE AVE
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City | PETERSBURG
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State | VA
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Zip | 23803-8604
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Country | US
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Telephone | 804-861-1452
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Fax | 804-861-8642
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PETER R JEFFREY
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Credential | DMIN
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Telephone | 804-861-1452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number | 20087298
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License Number State | VA
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