Provider Demographics
NPI:1669488086
Name:SHELTERED WORKSHOP OF ALTAVISTA
Entity Type:Organization
Organization Name:SHELTERED WORKSHOP OF ALTAVISTA
Other - Org Name:EMPOWER DAY SUPPORT OF CENTRAL VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-237-2432
Mailing Address - Street 1:1030 MCCONVILLE ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502
Mailing Address - Country:US
Mailing Address - Phone:434-237-2432
Mailing Address - Fax:434-237-2359
Practice Address - Street 1:1030 MCCONVILLE ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502
Practice Address - Country:US
Practice Address - Phone:434-237-2432
Practice Address - Fax:434-237-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1312-02-006251C00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4946961Medicaid