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General NPI Number Information
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NPI Number | 1467788992
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Entity Type | Organization
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Legal Business Name | CAVALIER CONGREGATE CONSORTIUM
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Dates
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Enumeration Date | 10/17/2009
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Last Update Date | 10/17/2009
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Provider Practice Location Address
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Address Line | 631 ROSE HILL DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-5235
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Country | US
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Telephone | 434-906-4565
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Fax |
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Provider Business Mailing Address
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Address Line | 631 ROSE HILL DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-5235
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Country | US
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Telephone | 434-906-4565
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. DANA-CARMEN DEL TORO
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Credential |
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Telephone | 434-293-5984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 1183-001
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License Number State | VA
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