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155 Wadsworth Dr North Chesterfield VA 23236-4500 | |
| (804) 533-1330 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 155 Wadsworth Dr, North Chesterfield, Virginia |
| Authorized Official Name and Position | Robyn Tanis (EXECUTIVE DIRECTOR CONTRACT MGMT) |
| Authorized Official Contact | 8565338762 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1317 Route 73 Suite 200 Mount Laurel NJ 08054-2202 Ph: (856) 439-6111 | 155 Wadsworth Dr North Chesterfield VA 23236-4500 Ph: (804) 533-1330 |
| NPI Number | 1437608437 |
|---|---|
| Provider Enumeration Date | 10/02/2016 |
| Last Update Date | 01/12/2024 |
| Certification Date | 01/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437608437 | NPI | - | NPPES |
| 2720-06-001 | Other | VA | STATE LICENSE |
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