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General NPI Number Information
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NPI Number | 1336330935
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Entity Type | Organization
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Legal Business Name | NEW HAVEN CHILDREN SERVICES
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 905 MAPLEGROVE DR
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City | RICHMOND
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State | VA
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Zip | 23223-2637
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Country | US
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Telephone | 804-644-2245
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Fax |
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Provider Business Mailing Address
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Address Line | 905 MAPLEGROVE DR
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City | RICHMOND
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State | VA
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Zip | 23223-2637
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Country | US
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Telephone | 804-644-2245
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Fax |
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Authorized Official
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Title or Position | CHEIF ADMINISTRATIVE OFFICER
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Name | MR. DOUGLAS EUGENE GLOVER
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Credential | M.ED
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Telephone | 804-644-2245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | SS35507
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License Number State | VA
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