Provider Demographics
NPI:1902349293
Name:A VILLAGE YOUTH & FAMILY SERVICES INC.
Entity Type:Organization
Organization Name:A VILLAGE YOUTH & FAMILY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHIDHRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, DSW
Authorized Official - Phone:804-551-7363
Mailing Address - Street 1:2025 E MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7072
Mailing Address - Country:US
Mailing Address - Phone:804-225-0749
Mailing Address - Fax:804-225-0753
Practice Address - Street 1:2025 E MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7072
Practice Address - Country:US
Practice Address - Phone:804-225-0749
Practice Address - Fax:804-225-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA516343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093138455Medicaid