Provider Demographics
NPI:1063936979
Name:ACHIEVABLE DEVELOPMENT SERVICES, LLC
Entity type:Organization
Organization Name:ACHIEVABLE DEVELOPMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARQUISE
Authorized Official - Middle Name:LONNELL
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-6399
Mailing Address - Street 1:1124 S WEDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4811
Mailing Address - Country:US
Mailing Address - Phone:804-833-6399
Mailing Address - Fax:804-464-4529
Practice Address - Street 1:1124 S WEDGEMONT DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4811
Practice Address - Country:US
Practice Address - Phone:804-833-6399
Practice Address - Fax:804-464-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid