MEDICARE: VOLUNTEERS OF AMERICA CHESAPEAKE, 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
1	324500000X	Substance Abuse Rehabilitation Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	175-01-006	OTHER	VA	INPATIENT SUBSTANCE ABUSE -ADULT

General Provider Information

NPI Number	:	1619514957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOLUNTEERS OF AMERICA CHESAPEAKE, INC.

Provider Business Mailing Address
First Line	:	1554 COLUMBIA PIKE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4667
Country	:	US
Telephone Number	:	703-228-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	1554 COLUMBIA PIKE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4667
Country	:	US
Telephone Number	:	703-228-0033
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT CONTROLLER
Name	:	TANEA MANNING
Credential	:	DO
Telephone Number	:	301-955-9476

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	12/05/2019

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