Provider Demographics
NPI:1710679147
Name:COMMUNITY INTERVENTION HEALTHCARE SERVICES VIRGINIA
Entity type:Organization
Organization Name:COMMUNITY INTERVENTION HEALTHCARE SERVICES VIRGINIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADELEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBIRONKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-929-3667
Mailing Address - Street 1:12 CLEMATIS CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4800 W HUNDRED RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1746
Practice Address - Country:US
Practice Address - Phone:410-505-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY INTERVENTION HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-24
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty