Provider Demographics
NPI:1396181020
Name:VIRGINIA SUPPORT GROUP, LLC
Entity Type:Organization
Organization Name:VIRGINIA SUPPORT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:TANEIL
Authorized Official - Last Name:FEREBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-927-3730
Mailing Address - Street 1:4663 HAYGOOD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5442
Mailing Address - Country:US
Mailing Address - Phone:757-962-9786
Mailing Address - Fax:757-962-9829
Practice Address - Street 1:4663 HAYGOOD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5442
Practice Address - Country:US
Practice Address - Phone:757-962-9786
Practice Address - Fax:757-962-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities