Provider Demographics
NPI:1639335987
Name:INTENSIVE COMMUNITY OUTREACH SERVICES LLC
Entity Type:Organization
Organization Name:INTENSIVE COMMUNITY OUTREACH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-317-7777
Mailing Address - Street 1:501 E FRANKLIN ST
Mailing Address - Street 2:SUITE 516
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2322
Mailing Address - Country:US
Mailing Address - Phone:804-317-7777
Mailing Address - Fax:
Practice Address - Street 1:501 E FRANKLIN ST
Practice Address - Street 2:SUITE 516
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2322
Practice Address - Country:US
Practice Address - Phone:804-317-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA118542305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization