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General NPI Number Information
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NPI Number | 1609155712
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Entity Type | Organization
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Legal Business Name | CITADEL FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 08/07/2011
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Last Update Date | 08/07/2011
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Provider Practice Location Address
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Address Line | 429 N MAIN ST
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City | SUFFOLK
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State | VA
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Zip | 23434-4424
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Country | US
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Telephone | 757-539-0268
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Fax | 757-539-0269
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Provider Business Mailing Address
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Address Line | 429 N MAIN ST
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City | SUFFOLK
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State | VA
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Zip | 23434-4424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | HEATHER INGRAHAM
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Credential |
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Telephone | 757-539-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1665-03-001
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License Number State | VA
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