Provider Demographics
NPI:1477882744
Name:INDIVIDUALS & OPPORTUNITIES DAY SUPPORT
Entity Type:Organization
Organization Name:INDIVIDUALS & OPPORTUNITIES DAY SUPPORT
Other - Org Name:THE UP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SPECIAL PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDYSZYN-CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MAQMRP, QMHP
Authorized Official - Phone:757-965-8669
Mailing Address - Street 1:800 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3326
Mailing Address - Country:US
Mailing Address - Phone:757-965-8693
Mailing Address - Fax:757-502-4960
Practice Address - Street 1:800 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3326
Practice Address - Country:US
Practice Address - Phone:757-965-8693
Practice Address - Fax:757-502-4960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD & FAMILY SERVICES OF EASTERN VIRGINIA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-16
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA346-05-011251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629158159Medicaid