Provider Demographics
NPI:1265462097
Name:PARC WORKSHOP, INC.
Entity Type:Organization
Organization Name:PARC WORKSHOP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-694-4211
Mailing Address - Street 1:674 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-4001
Mailing Address - Country:US
Mailing Address - Phone:276-694-4211
Mailing Address - Fax:276-694-2916
Practice Address - Street 1:674 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-4001
Practice Address - Country:US
Practice Address - Phone:276-694-4211
Practice Address - Fax:276-694-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA60602006251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA606-02-006OtherSERVICE LICENSE #