Provider Demographics
NPI:1760145072
Name:COMMUNITY SERVICES OF VIRGINIA INC.
Entity Type:Organization
Organization Name:COMMUNITY SERVICES OF VIRGINIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-497-1115
Mailing Address - Street 1:4551 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6442
Mailing Address - Country:US
Mailing Address - Phone:757-497-1115
Mailing Address - Fax:757-499-4215
Practice Address - Street 1:4551 PROFESSIONAL CIR STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6442
Practice Address - Country:US
Practice Address - Phone:757-497-1115
Practice Address - Fax:757-499-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care