Provider Demographics
NPI:1649756834
Name:AV COMMUNITY CONNECT
Entity type:Organization
Organization Name:AV COMMUNITY CONNECT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:SCPRS
Authorized Official - Phone:804-661-9369
Mailing Address - Street 1:1012 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5106
Mailing Address - Country:US
Mailing Address - Phone:804-661-9369
Mailing Address - Fax:
Practice Address - Street 1:921 HULL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4069
Practice Address - Country:US
Practice Address - Phone:804-661-9369
Practice Address - Fax:804-232-2227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VENABLE COMMUNITY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1568251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management