Organization
VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY
Active
Other names
VTCC-Residental Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
MELINDA S HANCOCK (CFO)
(804) 212-5145
Entity
Organization
Contact information
Practice address
1308 SHERWOOD AVE, RICHMOND, VA 23220
(804) 628-6643
(804) 828-2029
Mailing address
PO BOX 758997, BALTIMORE, MD 21275-0001
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
H1875
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207063
—
VA
Enumeration date
01/02/2007
Last updated
06/11/2018
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