Provider Demographics
NPI:1194151282
Name:THE VILLAGE CHILDREN AND FAMILY SERVICES
Entity type:Organization
Organization Name:THE VILLAGE CHILDREN AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:804-901-3458
Mailing Address - Street 1:7305 HANCOCK VILLAGE DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2771
Mailing Address - Country:US
Mailing Address - Phone:804-901-3458
Mailing Address - Fax:866-781-9464
Practice Address - Street 1:7305 HANCOCK VILLAGE DR
Practice Address - Street 2:SUITE 315
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2771
Practice Address - Country:US
Practice Address - Phone:804-901-3458
Practice Address - Fax:866-781-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1595-05-001253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care