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General NPI Number Information
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NPI Number | 1295295160
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE FAMILY SERVICES
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 2189 K V RD
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City | VICTORIA
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State | VA
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Zip | 23974-2538
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Country | US
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Telephone | 804-885-0773
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Fax |
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Provider Business Mailing Address
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Address Line | 3013 CRESSWELL RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23237-3459
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Country | US
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Telephone | 804-218-5649
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. PAMBLET SMITH JOHNSON
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Credential |
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Telephone | 804-955-5853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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