Provider Demographics
NPI:1558774679
Name:PPCS ENTERPRISES LLC
Entity Type:Organization
Organization Name:PPCS ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORETHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SELBY-DIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:757-839-4243
Mailing Address - Street 1:804 PARAPET RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-2420
Mailing Address - Country:US
Mailing Address - Phone:757-580-0451
Mailing Address - Fax:
Practice Address - Street 1:804 PARAPET RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2420
Practice Address - Country:US
Practice Address - Phone:757-580-0451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2088-03-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health