Provider Demographics
NPI:1366866659
Name:SUPPORT COORDINATORS LTD
Entity Type:Organization
Organization Name:SUPPORT COORDINATORS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-222-4946
Mailing Address - Street 1:914 N 35TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7602
Mailing Address - Country:US
Mailing Address - Phone:804-222-4946
Mailing Address - Fax:804-222-8492
Practice Address - Street 1:914 N 35TH ST FL 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7602
Practice Address - Country:US
Practice Address - Phone:804-873-1583
Practice Address - Fax:804-222-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0158053741171M00000X
VA0156636778171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0156636778Medicaid
VA0158053741Medicaid