Organization
CHESTERFIELD COMMUNITY SERVICES BOARD - ICF PINE FOREST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY FRIED (EXECUTIVE DIRECTOR)
(804) 768-7227
Entity
Organization
Contact information
Practice address
6801 LUCY CORR CT, CHESTERFIELD, VA 23832-6657
(804) 748-1227
(804) 717-6659
Mailing address
6801 LUCY CORR CT, CHESTERFIELD, VA 23832-6657
(804) 748-1227
(804) 717-6659
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
222-17-001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
VA
Enumeration date
02/06/2008
Last updated
09/15/2020
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