institution
Western Tidewater Community Services Board
Intellectual Disabilities Intermediate Care Facility in Suffolk, Virginia
NPI 1689928996

Western Tidewater Community Services Board is a Intellectual Disabilities Intermediate Care Facility based in Suffolk, VA. Western Tidewater Community Services Board practices in Suffolk, VA. The NPI Number for Western Tidewater Community Services Board is 1689928996 and holds a License No. 08401005 (Virginia).

The current practice location address for Western Tidewater Community Services Board is 4373 Pruden Boulevard, Suffolk, VA and can be reached out via phone at 757-255-7127 and via fax at 757-255-7139.

Location: 4373 Pruden Boulevard, Suffolk, VA, 23435-2762
institution
Provider Profile Details
NPI Number
1689928996
Provider Name
Western Tidewater Community Services Board
Credential
Provider Entity Type
Organization
Address
4373 Pruden Boulevard, Suffolk, VA, 23435-2762
Phone Number
757-255-7127
Fax Number
757-255-7139
Provider Enumeration Date
11/08/2012
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
4373 Pruden Boulevard
City
State
Zip
23434
Phone Number
757-255-7127
Fax Number
757-255-7139
person
Provider Business Mailing Address Details
Address
4373 Pruden Boulevard
City
State
Zip
23434
Phone Number
757-255-7127
Fax Number
757-255-7139
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
License No.
08401005 (Virginia)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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