Provider Demographics
NPI:1780942979
Name:BURRIESCI, DONALD CARL (CEO & MSW)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CARL
Last Name:BURRIESCI
Suffix:
Gender:M
Credentials:CEO & MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6966B FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1606
Mailing Address - Country:US
Mailing Address - Phone:804-323-6900
Mailing Address - Fax:804-323-9616
Practice Address - Street 1:6966B FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1606
Practice Address - Country:US
Practice Address - Phone:804-323-6900
Practice Address - Fax:804-323-9616
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO12250171M00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372600000XNursing Service Related ProvidersAdult Companion