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General NPI Number Information
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NPI Number | 1407215098
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Entity Type | Organization
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Legal Business Name | SUCCOR BEHAVORIAL SERVICES, LLC
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 16642 BRATTICE MILL RD
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City | CHESTERFIELD
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State | VA
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Zip | 23838-1726
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Country | US
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Telephone | 804-931-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 16642 BRATTICE MILL RD
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City | CHESTERFIELD
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State | VA
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Zip | 23838-1726
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Country | US
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Telephone | 804-931-1777
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. SHERRI BUONO
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Credential |
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Telephone | 804-931-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2330
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License Number State | VA
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