Provider Demographics
NPI:1346768546
Name:SPONSORED RESIDENTIAL SERVICES OF CENTRAL VIRGINIA, LLC
Entity Type:Organization
Organization Name:SPONSORED RESIDENTIAL SERVICES OF CENTRAL VIRGINIA, LLC
Other - Org Name:SRSCV
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:BSHA, LPN
Authorized Official - Phone:434-316-3861
Mailing Address - Street 1:214 COLLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2506
Mailing Address - Country:US
Mailing Address - Phone:434-316-3861
Mailing Address - Fax:434-534-3031
Practice Address - Street 1:214 COLLINGTON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2506
Practice Address - Country:US
Practice Address - Phone:434-316-3861
Practice Address - Fax:434-534-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2758320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities