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General NPI Number Information
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NPI Number | 1740217918
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Entity Type | Organization
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Legal Business Name | ST MARYS HOME FOR DISABLED CHILDREN
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 6171 KEMPSVILLE CIRCLE
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City | NORFOLK
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State | VA
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Zip | 23502-3930
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Country | US
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Telephone | 757-622-2208
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Fax | 757-640-0147
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Provider Business Mailing Address
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Address Line | 6171 KEMPSVILLE CIRCLE
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City | NORFOLK
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State | VA
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Zip | 23502-3930
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Country | US
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Telephone | 757-622-2208
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Fax | 757-640-0147
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM C GIERMAK
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Credential |
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Telephone | 757-622-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 30414001
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License Number State | VA
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