MEDICARE: COMMUNITY VENTURES MANAGEMENT

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		VA

General Provider Information

NPI Number	:	1902093453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY VENTURES MANAGEMENT

Provider Business Mailing Address
First Line	:	PO BOX 325
Second Line	:
City	:	WOODSTOCK
State	:	MD
Zip	:	21163-0325
Country	:	US
Telephone Number	:	410-480-0019
Fax Number	:	410-313-8432

Provider Business Practice Location Address
First Line	:	8393 CARDOVA CIR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1548
Country	:	US
Telephone Number	:	410-480-0019
Fax Number	:	410-313-8432

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	PHILLIP DEBERRY JR.
Credential	:
Telephone Number	:	410-480-0019

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	09/28/2007

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