Organization
EDGEWOOD GROUP FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS CROCKER (DOS)
(804) 648-0671
Entity
Organization
Contact information
Practice address
4906 FITZHUGH AVE STE 104, RICHMOND, VA 23230-3520
(804) 648-0671
(804) 648-0672
Mailing address
4906 FITZHUGH AVE STE 104, RICHMOND, VA 23230-3520
(804) 648-0671
(804) 648-0672
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
709
VA
Other
Enumeration date
03/01/2011
Last updated
03/01/2011
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