Provider Demographics
NPI:1508161399
Name:VIRAGE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:VIRAGE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-337-7025
Mailing Address - Street 1:6221 S CLAIBORNE AVE
Mailing Address - Street 2:303
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4142
Mailing Address - Country:US
Mailing Address - Phone:504-298-8675
Mailing Address - Fax:
Practice Address - Street 1:6221 S CLAIBORNE AVE
Practice Address - Street 2:303
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-4142
Practice Address - Country:US
Practice Address - Phone:504-298-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40166180K251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services