Organization
MIDDLE PENINSULA NORTHERN NECK CSB
Active
Parent organization
RURAL INFANT SERVICE PROGRAM
Organization subpart
Yes
Provider details
NPI number
Legal business name
RURAL INFANT SERVICE PROGRAM
Authorized official
KATHERINE PHILLIPS MAED (DIRECTOR)
(804) 758-5250
Entity
Organization
Contact information
Practice address
5372 OLD VIRGINIA ST, SUITE B, URBANNA, VA 23175-2179
(804) 758-5250
(804) 758-5183
Mailing address
5372B OLD VIRGINIA ST, URBANNA, VA 23175
(804) 758-5250
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
PROV0641855
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4978137
—
VA
Enumeration date
05/10/2017
Last updated
05/10/2017
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