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Organization

SOUTHEASTERN VIRGINIA AREAWIDE MODEL PROGRAM

Active
Other names
Senior Services of Southeastern Virginia
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOHN N SKIRVEN (CEO)
(757) 222-4510
Entity
Organization

Contact information

Practice address
6350 CENTER DR, SUITE101, NORFOLK, VA 23502-4107
(757) 461-9481
(757) 461-1068
Mailing address
6350 CENTER DR, SUITE101, NORFOLK, VA 23502-4107
(757) 461-9481
(757) 461-1068

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
1060267354
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0160267354
VA
05
0161745051
VA
Enumeration date
06/10/2014
Last updated
06/10/2014
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