Provider Demographics
NPI:1003342445
Name:COMMONWEALTH DAY SUPPORT
Entity Type:Organization
Organization Name:COMMONWEALTH DAY SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-908-4635
Mailing Address - Street 1:5601 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5046
Practice Address - Country:US
Practice Address - Phone:804-908-4635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2076251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health