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General NPI Number Information
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NPI Number | 1649756834
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Entity Type | Organization
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Legal Business Name | AV COMMUNITY CONNECT
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 921 HULL ST
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City | RICHMOND
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State | VA
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Zip | 23224-4069
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Country | US
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Telephone | 804-661-9369
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Fax | 804-232-2227
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Provider Business Mailing Address
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Address Line | 1012 N 20TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-5106
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Country | US
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Telephone | 804-661-9369
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS ALECIA M VENABLE
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Credential | SCPRS
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Telephone | 804-661-9369
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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 | 1568
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License Number State | VA
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