Provider Demographics
NPI:1285472126
Name:PREMIER HEALTH SERVICES OF VIRGINIA
Entity type:Organization
Organization Name:PREMIER HEALTH SERVICES OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:W
Authorized Official - Last Name:COSBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:703-789-5880
Mailing Address - Street 1:8158 CARRIAGE BEND LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8158 CARRIAGE BEND LN
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4352
Practice Address - Country:US
Practice Address - Phone:703-789-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services