MEDICARE: VIRGINIA SUPPORTIVE HOUSING

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	1003-03-001	VA

General Provider Information

NPI Number	:	1679737886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA SUPPORTIVE HOUSING

Provider Business Mailing Address
First Line	:	PO BOX 8585
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-0585
Country	:	US
Telephone Number	:	804-836-1051
Fax Number	:	804-788-6827

Provider Business Practice Location Address
First Line	:	1010 N THOMPSON ST
Second Line	:	SUITE 200
City	:	RICHMOND
State	:	VA
Zip	:	23230-4911
Country	:	US
Telephone Number	:	804-788-6825
Fax Number	:	804-788-6827

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ALICE TOUSIGNANT
Credential	:
Telephone Number	:	804-836-1051

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	07/16/2008

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