Provider Demographics
NPI:1184809287
Name:CITTY INC.
Entity type:Organization
Organization Name:CITTY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAO/PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:804-218-0935
Mailing Address - Street 1:177 ELSING GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:23075-2451
Mailing Address - Country:US
Mailing Address - Phone:804-218-0935
Mailing Address - Fax:
Practice Address - Street 1:177 ELSING GREEN WAY
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-2451
Practice Address - Country:US
Practice Address - Phone:804-218-0935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS-343-07320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness