Provider Demographics
NPI:1295295160
Name:SUPPORTIVE FAMILY SERVICES
Entity type:Organization
Organization Name:SUPPORTIVE FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMBLET
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-955-5853
Mailing Address - Street 1:3013 CRESSWELL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-3459
Mailing Address - Country:US
Mailing Address - Phone:804-218-5649
Mailing Address - Fax:
Practice Address - Street 1:2189 K V RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:VA
Practice Address - Zip Code:23974-2538
Practice Address - Country:US
Practice Address - Phone:804-885-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)