Provider Demographics
NPI:1942360201
Name:PETERSBURG CASE MANAGEMENT & SERVICES
Entity Type:Organization
Organization Name:PETERSBURG CASE MANAGEMENT & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:QUINCY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:804-721-3856
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23804-0725
Mailing Address - Country:US
Mailing Address - Phone:804-721-3856
Mailing Address - Fax:804-861-0426
Practice Address - Street 1:114 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4511
Practice Address - Country:US
Practice Address - Phone:804-721-3856
Practice Address - Fax:804-861-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management