Provider Demographics
NPI:1477561827
Name:POINDEXTERS RES CHILD CARE FACILITY
Entity Type:Organization
Organization Name:POINDEXTERS RES CHILD CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:C
Authorized Official - Last Name:POINDEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-586-0518
Mailing Address - Street 1:1102 POINDEXTER LANE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523
Mailing Address - Country:US
Mailing Address - Phone:540-586-0518
Mailing Address - Fax:540-586-5448
Practice Address - Street 1:1102 POINDEXTER LANE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523
Practice Address - Country:US
Practice Address - Phone:540-586-0518
Practice Address - Fax:540-586-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA18914001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities