Provider Demographics
NPI:1184960908
Name:CAPITAL CENTER OF VIRGINIA
Entity type:Organization
Organization Name:CAPITAL CENTER OF VIRGINIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-359-8821
Mailing Address - Street 1:PO BOX 4255
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-8255
Mailing Address - Country:US
Mailing Address - Phone:804-359-8821
Mailing Address - Fax:804-359-8827
Practice Address - Street 1:1704 W LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4312
Practice Address - Country:US
Practice Address - Phone:804-359-8821
Practice Address - Fax:804-359-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1227158251B00000X, 252Y00000X, 163W00000X, 163WC0400X, 163WP1700X, 163WM0102X, 374J00000X, 374U00000X, 251J00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WP1700XNursing Service ProvidersRegistered NursePerinatalGroup - Multi-Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty