Organization
INTENSIVE COMMUNITY OUTREACH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BERNARD LAMONT HEYWARD (PRESIDENT)
(804) 551-4155
Entity
Organization
Contact information
Practice address
1524 MERRIMAC TRAIL, SUITE J, WILIAMSBURG, VA 23815
(804) 521-4327
Mailing address
501 E. FRANKLIN STREET, SUITE 516, RICHMOND, VA 23219
(804) 521-4327
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
07313155018008081414
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639335987
—
VA
Enumeration date
05/18/2009
Last updated
05/18/2009
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