Provider Demographics
NPI:1558371898
Name:SERVICESOURCE INC
Entity Type:Organization
Organization Name:SERVICESOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF METRO REGI
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-461-6140
Mailing Address - Street 1:6295 EDSALL RD STE 175
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2670
Mailing Address - Country:US
Mailing Address - Phone:703-461-6000
Mailing Address - Fax:703-461-3906
Practice Address - Street 1:6295 EDSALL RD STE 175
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2670
Practice Address - Country:US
Practice Address - Phone:703-461-6000
Practice Address - Fax:703-461-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-06-17
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-06-17
Provider Licenses
StateLicense IDTaxonomies
VA262251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services