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General NPI Number Information
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NPI Number | 1952582751
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Entity Type | Organization
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Legal Business Name | CHESTERFIELD YOUTH GROUP HOME
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 9610 KRAUSE RD
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6717
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Country | US
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Telephone | 180-474-8161
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Fax | 180-474-8129
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Provider Business Mailing Address
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Address Line | 9610 KRAUSE RD
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6717
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Country | US
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Telephone | 180-474-8161
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Fax | 180-474-8129
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. DEBORAH S. DUGGER
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Credential |
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Telephone | 18047481857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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