Provider Demographics
NPI:1740094796
Name:INSIDEOUT COMPLETE CARE GROUP HOME INC.
Entity type:Organization
Organization Name:INSIDEOUT COMPLETE CARE GROUP HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:804-687-4136
Mailing Address - Street 1:7305 CUMBERMEADE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-1929
Mailing Address - Country:US
Mailing Address - Phone:804-687-4136
Mailing Address - Fax:
Practice Address - Street 1:7305 CUMBERMEADE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-1929
Practice Address - Country:US
Practice Address - Phone:804-687-4136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities