Provider Demographics
NPI:1639513781
Name:CITY OF VIRGINIA BEACH HUMAN SERVICES
Entity Type:Organization
Organization Name:CITY OF VIRGINIA BEACH HUMAN SERVICES
Other - Org Name:INDIAN RIVER ICF/IID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-385-0687
Mailing Address - Street 1:3432 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4420
Mailing Address - Country:US
Mailing Address - Phone:757-385-0687
Mailing Address - Fax:757-306-5801
Practice Address - Street 1:2525 LIFETIME CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1499
Practice Address - Country:US
Practice Address - Phone:757-385-5575
Practice Address - Fax:757-416-5083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF VIRGINIA BEACH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA26101001310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness