Provider Demographics
NPI:1992039101
Name:FOR CHILDREN'S SAKE OF VIRGINIA
Entity Type:Organization
Organization Name:FOR CHILDREN'S SAKE OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TFC PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:703-817-9890
Mailing Address - Street 1:14900 BOGLE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1756
Mailing Address - Country:US
Mailing Address - Phone:703-817-9890
Mailing Address - Fax:703-817-9860
Practice Address - Street 1:14900 BOGLE DR
Practice Address - Street 2:STE 200
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1756
Practice Address - Country:US
Practice Address - Phone:703-817-9890
Practice Address - Fax:703-817-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency