Provider Demographics
NPI:1730773417
Name:COLLABORATIVE HEALTH OUTREACH OF VIRGINIA
Entity type:Organization
Organization Name:COLLABORATIVE HEALTH OUTREACH OF VIRGINIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:HAUSLER
Authorized Official - Last Name:JOYNER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:757-402-3707
Mailing Address - Street 1:5215 COLLEY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2172
Mailing Address - Country:US
Mailing Address - Phone:757-402-3707
Mailing Address - Fax:
Practice Address - Street 1:5215 COLLEY AVE STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2172
Practice Address - Country:US
Practice Address - Phone:757-675-2719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002437OtherLICENSE