Provider Demographics
NPI:1861403685
Name:CRAWFORD FIRST EDUCATION
Entity type:Organization
Organization Name:CRAWFORD FIRST EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-393-7244
Mailing Address - Street 1:825 CRAWFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2301
Mailing Address - Country:US
Mailing Address - Phone:757-391-6675
Mailing Address - Fax:757-691-6651
Practice Address - Street 1:825 CRAWFORD PKWY
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2301
Practice Address - Country:US
Practice Address - Phone:757-391-6675
Practice Address - Fax:757-691-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA842-02-029320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010285453Medicaid