Provider Demographics
NPI:1356115950
Name:RANDOLPH & DAVISON ENTERPRISES INC.
Entity type:Organization
Organization Name:RANDOLPH & DAVISON ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NITA
Authorized Official - Middle Name:VIANN RANDOLPH
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-605-9845
Mailing Address - Street 1:1889 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2730
Mailing Address - Country:US
Mailing Address - Phone:804-605-9845
Mailing Address - Fax:804-895-7853
Practice Address - Street 1:6421 BELMONT RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8213
Practice Address - Country:US
Practice Address - Phone:804-605-9845
Practice Address - Fax:804-895-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No302F00000XManaged Care OrganizationsExclusive Provider Organization