Provider Demographics
NPI:1588216683
Name:TRADITIONAL CARE SERVICES, LLC.
Entity type:Organization
Organization Name:TRADITIONAL CARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MPA
Authorized Official - Prefix:
Authorized Official - First Name:TAMICO
Authorized Official - Middle Name:JARNINE
Authorized Official - Last Name:PRIESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-726-5333
Mailing Address - Street 1:2101 EXECUTIVE DR STE 590
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 EXECUTIVE DR STE 590
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2404
Practice Address - Country:US
Practice Address - Phone:757-726-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health