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General NPI Number Information
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NPI Number | 1710679147
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Entity Type | Organization
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Legal Business Name | COMMUNITY INTERVENTION HEALTHCARE SERVICES VIRGINIA
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 4800 W HUNDRED RD
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City | CHESTER
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State | VA
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Zip | 23831-1746
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Country | US
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Telephone | 410-505-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 12 CLEMATIS CT
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5032
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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 | CHIEF EXECUTIVE OFFICER
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Name | MR. ADELEKE IBIRONKE
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Credential |
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Telephone | 443-929-3667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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