Provider Demographics
NPI:1144455064
Name:ENDEPENDENCE CENTER, INC.
Entity type:Organization
Organization Name:ENDEPENDENCE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADVOCACY AND SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-351-1584
Mailing Address - Street 1:6300 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2827
Mailing Address - Country:US
Mailing Address - Phone:757-461-8007
Mailing Address - Fax:757-461-5375
Practice Address - Street 1:6300 E VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2827
Practice Address - Country:US
Practice Address - Phone:757-461-8007
Practice Address - Fax:757-461-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0087429285Medicaid