MEDICARE: FAMILIES UNITED SUPPORT SERVICES LLC

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	320800000X	Mental Illness Community Based Residential Treatment Facility
2	251S00000X	Community/Behavioral Health Agency	2590-03-001	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730690694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILIES UNITED SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	249 CENTRAL PARK AVE STE 300-194
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3099
Country	:	US
Telephone Number	:	757-201-9832
Fax Number	:	757-913-1366

Provider Business Practice Location Address
First Line	:	249 CENTRAL PARK AVE STE 300-194
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3099
Country	:	US
Telephone Number	:	757-201-9832
Fax Number	:	757-913-1366

Authorized Official
Title or Position	:	CEO
Name	:	TAMMY COPELAND
Credential	:
Telephone Number	:	347-228-2665

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	05/22/2024

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