Provider Demographics
NPI:1245943364
Name:COMMONWEALTH BEHAVIORAL CARE SERVICES LLC
Entity type:Organization
Organization Name:COMMONWEALTH BEHAVIORAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-479-6969
Mailing Address - Street 1:43 RIVES RD STE 9
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9255
Mailing Address - Country:US
Mailing Address - Phone:804-479-6969
Mailing Address - Fax:
Practice Address - Street 1:43 RIVES RD STE 9
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9255
Practice Address - Country:US
Practice Address - Phone:804-479-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health