Provider Demographics
NPI:1306031596
Name:CHARLES CITY COUNTY BOARD OF SUPERVISORS
Entity Type:Organization
Organization Name:CHARLES CITY COUNTY BOARD OF SUPERVISORS
Other - Org Name:CHARLES CITY COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY COUNTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-652-4721
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23030-0128
Mailing Address - Country:US
Mailing Address - Phone:804-652-4721
Mailing Address - Fax:804-829-5819
Practice Address - Street 1:10900 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:VA
Practice Address - Zip Code:23030-3426
Practice Address - Country:US
Practice Address - Phone:804-652-4702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA827341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance