Provider Demographics
NPI:1063856623
Name:COMMUNITY ASSISTANCE NETWORK, LLC
Entity Type:Organization
Organization Name:COMMUNITY ASSISTANCE NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-306-1450
Mailing Address - Street 1:5737 S LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-4431
Mailing Address - Country:US
Mailing Address - Phone:804-525-5213
Mailing Address - Fax:
Practice Address - Street 1:5737 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-4431
Practice Address - Country:US
Practice Address - Phone:804-525-5213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2002-02-006251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services