Provider Demographics
NPI:1427779800
Name:ERVIN'S VILLAGE FAMILY SUPPORT LLC
Entity type:Organization
Organization Name:ERVIN'S VILLAGE FAMILY SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COBBS
Authorized Official - Suffix:
Authorized Official - Credentials:SUP-LCSW MSW MTS
Authorized Official - Phone:434-713-3340
Mailing Address - Street 1:625 PINEY FOREST RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2867
Mailing Address - Country:US
Mailing Address - Phone:434-713-3340
Mailing Address - Fax:
Practice Address - Street 1:625 PINEY FOREST RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2867
Practice Address - Country:US
Practice Address - Phone:434-713-3340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty