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General NPI Number Information
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NPI Number | 1396778726
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Entity Type | Organization
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Legal Business Name | CARPE DIEM OF VIRGINIA
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3808 POPLAR HILL RD SUITE A
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5534
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Country | US
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Telephone | 757-638-5500
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Fax | 757-638-0256
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Provider Business Mailing Address
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Address Line | 3500 TEJO LN SUITE 105
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5258
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Country | US
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Telephone | 757-638-5500
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Fax | 757-638-0256
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN ELIOT FAIRCLOTH
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Credential | MA
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Telephone | 757-638-5500
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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 | CO-22-05
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License Number State | VA
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