Provider Demographics
NPI:1962194670
Name:VIRGINIA HEALTHCARE SUPPORTS, INC
Entity type:Organization
Organization Name:VIRGINIA HEALTHCARE SUPPORTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AIAH
Authorized Official - Middle Name:BARKU
Authorized Official - Last Name:KOROMA
Authorized Official - Suffix:
Authorized Official - Credentials:PARTNER
Authorized Official - Phone:240-481-2418
Mailing Address - Street 1:4104 E PARHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2746
Mailing Address - Country:US
Mailing Address - Phone:240-481-2418
Mailing Address - Fax:
Practice Address - Street 1:4104 E PARHAM RD STE B
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2746
Practice Address - Country:US
Practice Address - Phone:240-481-2418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health