Organization
WEST PETERSBURG SENIOR ADULT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER R JEFFREY DMIN (DIRECTOR)
(804) 861-1452
Entity
Organization
Contact information
Practice address
25720 GREENSVILLE AVE, PETERSBURG, VA 23803-8604
(804) 861-1452
(804) 861-8642
Mailing address
25720 GREENSVILLE AVE, PETERSBURG, VA 23803-8604
(804) 861-1452
(804) 861-8642
Taxonomy
Speciality
Code
Description
License number
State
385HR2065X
Child Physical Disabilities Respite Care
Primary
20087298
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20087298
—
VA
Enumeration date
02/10/2009
Last updated
02/12/2009
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