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General NPI Number Information
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NPI Number | 1912235235
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Entity Type | Organization
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Legal Business Name | INFLUENTIAL FAMILY SERVICE, INC.
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 3122 W. MARSHALL ST 10
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City | RICHMOND
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State | VA
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Zip | 23230-4726
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Country | US
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Telephone | 804-355-1853
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Fax |
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Provider Business Mailing Address
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Address Line | 3122 W. MARSHALL ST 10
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City | RICHMOND
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State | VA
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Zip | 23230
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Country | US
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Telephone | 804-355-1853
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. DERRICK CHAVIS
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Credential |
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Telephone | 804-355-1853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1346-05-001
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1346-05-001
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License Number State | VA
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