Organization
EASTER SEALS VIRGINIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA HAZELBAKER (PRESIDENT/CEO)
(804) 287-1007
Entity
Organization
Contact information
Practice address
900 CAMP EASTER SEALS RD, NEW CASTLE, VA 24127-9566
(540) 864-5750
Mailing address
8003 FRANKLIN FARMS DR, RICHMOND, VA 23229-5107
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170325
ANTHEM
VA
Enumeration date
08/16/2007
Last updated
08/16/2007
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