Provider Demographics
NPI:1861096679
Name:HIS SERVICE CENTER, LLC
Entity type:Organization
Organization Name:HIS SERVICE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:SUSANE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-433-8247
Mailing Address - Street 1:4808 CHATHAM GROVE PL
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1159
Mailing Address - Country:US
Mailing Address - Phone:804-433-8247
Mailing Address - Fax:804-800-2271
Practice Address - Street 1:4808 CHATHAM GROVE PL
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1159
Practice Address - Country:US
Practice Address - Phone:804-433-8247
Practice Address - Fax:804-800-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness