Provider Demographics
NPI:1831710524
Name:VIRGINIA STATE PROPERTIES LLC
Entity type:Organization
Organization Name:VIRGINIA STATE PROPERTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-639-8443
Mailing Address - Street 1:509 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4424
Mailing Address - Country:US
Mailing Address - Phone:757-639-8443
Mailing Address - Fax:
Practice Address - Street 1:509 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4424
Practice Address - Country:US
Practice Address - Phone:757-639-8443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health