MEDICARE: ACCESS REGIONAL TASKFROCE, 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	251C00000X	Developmentally Disabled Services Day Training Agency		VA

General Provider Information

NPI Number	:	1700033081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS REGIONAL TASKFROCE, INC

Provider Business Mailing Address
First Line	:	PO BOX 6082
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-0082
Country	:	US
Telephone Number	:	804-307-0026
Fax Number	:	804-525-4314

Provider Business Practice Location Address
First Line	:	2513 CHAMBERLAYNE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-4214
Country	:	US
Telephone Number	:	804-307-0026
Fax Number	:	804-525-4313

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOSEPH TYREICE HACKETT
Credential	:
Telephone Number	:	804-525-4314

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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