Provider Demographics
NPI:1972801785
Name:COMMUNITY DIRECT SERVICES, INC.
Entity Type:Organization
Organization Name:COMMUNITY DIRECT SERVICES, INC.
Other - Org Name:COMMUNITY DIRECT SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOMAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-965-4899
Mailing Address - Street 1:5520 GREENWICH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6541
Mailing Address - Country:US
Mailing Address - Phone:757-962-6392
Mailing Address - Fax:757-962-6539
Practice Address - Street 1:5520 GREENWICH ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-962-6392
Practice Address - Fax:757-962-6539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
VA593253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health