Provider Demographics
NPI:1336177427
Name:VOLUNTEERS OF AMERICA CHESAPEAKE, INC.
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA CHESAPEAKE, INC.
Other - Org Name:BAKER HOUSE - VIRGINIA BEACH MENTAL RETARDATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:301-389-3166
Mailing Address - Street 1:7505 GREENWAY CENTER DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-389-3156
Mailing Address - Fax:301-389-3166
Practice Address - Street 1:5677 HERBERT MOORE ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:301-389-3156
Practice Address - Fax:301-389-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X, 315P00000X, 320900000X
175-01-001320600000X, 320900000X
VA4947941320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251V00000XAgenciesVoluntary or Charitable
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4947941Medicaid