Organization
CHESTERFIELD COMMUNITY SERVICES BOARD-ICF MR GALLOWAY PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH BURCHAM (EXECUTIVE DIRECTOR)
(804) 768-7220
Entity
Organization
Contact information
Practice address
6801 LUCY CORR CT, CHESTERFIELD, VA 23832-6657
(804) 748-1227
(804) 717-6659
Mailing address
6801 LUCY CORR CT, CHESTERFIELD, VA 23832-6657
(804) 748-1227
(804) 717-6659
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945352
—
VA
Enumeration date
07/11/2014
Last updated
07/11/2014
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