Provider Demographics
NPI: | 1033273354 |
---|---|
Name: | NORFOLK DEPARTMENT OF PUBLIC HEALTH |
Entity Type: | Organization |
Organization Name: | NORFOLK DEPARTMENT OF PUBLIC HEALTH |
Other - Org Name: | CHILD DEVELOPMENT CLINIC |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | BUSINESS MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | BOYD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MBA |
Authorized Official - Phone: | 757-683-2796 |
Mailing Address - Street 1: | 830 SOUTHAMPTON AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | NORFOLK |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23510-1001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-683-2796 |
Mailing Address - Fax: | 757-683-8878 |
Practice Address - Street 1: | 830 SOUTHAMPTON AVE |
Practice Address - Street 2: | |
Practice Address - City: | NORFOLK |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23510-1001 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-683-2796 |
Practice Address - Fax: | 757-683-8878 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-12-21 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |