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NPI Code Detail

MEDICARE: CIVITAS HEALTH SERVICES, INC.

MEDICARE: CIVITAS HEALTH SERVICES, INC.
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
1251S00000XCommunity/Behavioral Health Agency1588VA

General Provider Information

NPI Number : 1366727984
Entity Type Code : Organization
Provider Name (Legal Business Name) : CIVITAS HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 5663 S LABURNUM AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23231-4418
Country : US
Telephone Number : 804-737-3917
Fax Number : 804-737-3940
Provider Business Practice Location Address
First Line : 5663 S LABURNUM AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23231-4418
Country : US
Telephone Number : 804-737-3917
Fax Number : 804-737-3940
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. LEMAR BOWERS
Credential :
Telephone Number : 804-737-3917
Provider Enumeration Date : 10/14/2011
Last Update Date : 07/21/2016

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Directions to “CIVITAS HEALTH SERVICES, INC. ” Practice Location

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