MEDICARE: LDS FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194941898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDS FAMILY SERVICES

Provider Business Mailing Address
First Line	:	8110 VIRGINIA PINE CT
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23237-2203
Country	:	US
Telephone Number	:	804-743-0727
Fax Number	:

Provider Business Practice Location Address
First Line	:	8110 VIRGINIA PINE CT
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23237-2203
Country	:	US
Telephone Number	:	804-743-0727
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. KURT OLSSON
Credential	:
Telephone Number	:	804-743-0727

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	06/06/2008

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