Provider Demographics
NPI:1932396173
Name:COMMUNITY SERVICES OF VA
Entity Type:Organization
Organization Name:COMMUNITY SERVICES OF VA
Other - Org Name:COMMUNITY SERVICES OF NC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROGRAM SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-971-0808
Mailing Address - Street 1:PO BOX 43270
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-0021
Mailing Address - Country:US
Mailing Address - Phone:704-971-0808
Mailing Address - Fax:
Practice Address - Street 1:8835 RED TAIL CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3164
Practice Address - Country:US
Practice Address - Phone:704-971-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities