Provider Demographics
NPI:1992724561
Name:ST. JOHN'S COMMUNITY SERVICES- VIRGINIA
Entity type:Organization
Organization Name:ST. JOHN'S COMMUNITY SERVICES- VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VA. STATE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON-CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-914-2755
Mailing Address - Street 1:7611 LITTLE RIVER TURNPIKE
Mailing Address - Street 2:SUITE 404 WEST
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-914-2755
Mailing Address - Fax:703-914-5437
Practice Address - Street 1:7611 LITTLE RIVER TURNPIKE
Practice Address - Street 2:SUITE 404 WEST
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-914-2755
Practice Address - Fax:703-914-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA194-01-001251C00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities