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General NPI Number Information
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NPI Number | 1902349293
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Entity Type | Organization
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Legal Business Name | A VILLAGE YOUTH & FAMILY SERVICES INC.
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 2025 E MAIN ST STE 104
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City | RICHMOND
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State | VA
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Zip | 23223-7072
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Country | US
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Telephone | 804-225-0749
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Fax | 804-225-0753
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Provider Business Mailing Address
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Address Line | 2025 E MAIN ST STE 104
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City | RICHMOND
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State | VA
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Zip | 23223-7072
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Country | US
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Telephone | 804-225-0749
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Fax | 804-225-0753
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Authorized Official
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Title or Position | CEO
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Name | KHIDHRA S POOLE
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Credential | LCSW, DSW
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Telephone | 804-551-7363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 516
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License Number State | VA
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