Provider Demographics
NPI:1497884969
Name:CHESTERFIELD COMMUNITY SERVICES BOARD-INFANT PROGRAM
Entity Type:Organization
Organization Name:CHESTERFIELD COMMUNITY SERVICES BOARD-INFANT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-768-7220
Mailing Address - Street 1:101 BUFORD ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-748-1227
Mailing Address - Fax:804-717-6659
Practice Address - Street 1:101 BUFORD ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-748-1227
Practice Address - Fax:804-717-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA252Y00000X, 225XP0200X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497884969Medicaid