Provider Demographics
NPI:1831289669
Name:FAMILY REDIRECTION INSTITUTE, INC.
Entity Type:Organization
Organization Name:FAMILY REDIRECTION INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-398-0200
Mailing Address - Street 1:5062 PORTSMOUTH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1426
Mailing Address - Country:US
Mailing Address - Phone:757-398-0200
Mailing Address - Fax:757-398-0057
Practice Address - Street 1:5062 PORTSMOUTH BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-1426
Practice Address - Country:US
Practice Address - Phone:757-398-0200
Practice Address - Fax:757-398-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA333-05-001251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004946481Medicaid