Provider Demographics
NPI:1497279434
Name:RESILIENT HEALTH AND COMMUNITY SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:RESILIENT HEALTH AND COMMUNITY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:V
Authorized Official - Last Name:TAYAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-224-0949
Mailing Address - Street 1:PO BOX 4202
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-4202
Mailing Address - Country:US
Mailing Address - Phone:276-224-0949
Mailing Address - Fax:
Practice Address - Street 1:300 FRANKLIN ST STE 231
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2162
Practice Address - Country:US
Practice Address - Phone:276-224-0949
Practice Address - Fax:
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
VA2696-03-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2696-03-001Medicaid