Provider Demographics
NPI:1760419113
Name:VOLUNTEERS OF AMERICA CHESAPEAKE, INC.
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA CHESAPEAKE, INC.
Other - Org Name:NORTHERN VIRGINIA COMMUNITY LIVING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:301-389-3166
Mailing Address - Street 1:12940 HARBOR VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:301-389-3156
Mailing Address - Fax:301-389-3166
Practice Address - Street 1:12940 HARBOR VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:301-389-3156
Practice Address - Fax:301-389-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X, 320900000X
VA175-01-001320600000X, 320900000X
VA4947941320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251V00000XAgenciesVoluntary or Charitable
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4948149Medicaid
VA4948419Medicaid