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General NPI Number Information
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NPI Number | 1669482501
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Entity Type | Organization
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Legal Business Name | TIDEWATER REGIONAL GROUP HOME COMMISSION
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 2404 AIRLINE BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2912
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Country | US
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Telephone | 757-488-9382
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Fax | 757-488-9564
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Provider Business Mailing Address
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Address Line | 2404 AIRLINE BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2912
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Country | US
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Telephone | 757-488-9161
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Fax | 757-488-9564
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LINDA FILIPPI
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Credential | L.C.S.W., C.S.O.T.P.
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Telephone | 757-488-9161
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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 | 08305001
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License Number State | VA
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