Provider Demographics
NPI:1225399249
Name:F.A.C.E.S. COMMUNITY SERVICES
Entity Type:Organization
Organization Name:F.A.C.E.S. COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-773-9627
Mailing Address - Street 1:PO BOX 9911
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-0911
Mailing Address - Country:US
Mailing Address - Phone:757-773-9627
Mailing Address - Fax:757-257-4775
Practice Address - Street 1:3624 MARDEAN DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4476
Practice Address - Country:US
Practice Address - Phone:757-773-9627
Practice Address - Fax:757-257-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1105320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457505943Medicaid