Provider Demographics
NPI:1366627754
Name:HALLMARK YOUTHCARE RICHMOND
Entity Type:Organization
Organization Name:HALLMARK YOUTHCARE RICHMOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:DI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:804-784-6521
Mailing Address - Street 1:4914 RADFORD AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3538
Mailing Address - Country:US
Mailing Address - Phone:804-980-7532
Mailing Address - Fax:804-545-0854
Practice Address - Street 1:4914 RADFORD AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3538
Practice Address - Country:US
Practice Address - Phone:804-980-7532
Practice Address - Fax:804-545-0854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALLMARK YOUTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health