Organization
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
Active
Other names
Vince's Place/Chase's Way ICF/IID
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIOS PERATSAKIS PD, MS, LPC (EXECUTIVE DIRECTOR)
(757) 255-7133
Entity
Organization
Contact information
Practice address
4373 PRUDEN BOULEVARD, SUFFOLK, VA 23434
(757) 255-7127
(757) 255-7139
Mailing address
7025 HARBOUR VIEW BLVD STE 119, SUFFOLK, VA 23435-2762
(757) 966-2805
(757) 673-2586
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
08401005
VA
Other
Enumeration date
11/08/2012
Last updated
01/29/2024
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