Independent Family Services, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

2016 Issued in VA

Legal business name

INDEPENDENT FAMILY SERVICES, LLC

Practice address

1953 Coggin St
Petersburg, VA 23805-2009

Phone

(804) 451-9935

Fax

(804) 504-5573

NPI assigned

Aug 20, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cleveland Thomas Walker Sr.

Title

Ceo

Phone

(804) 451-9935

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376956800000",
    "number": "1215360706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1953 COGGIN ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052009",
            "telephone_number": "804-451-9935",
            "fax_number": "804-504-5573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1953 COGGIN ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052009",
            "telephone_number": "804-451-9935",
            "fax_number": "804-504-5573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT FAMILY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-20",
        "last_updated": "2013-08-20",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "CLEVELAND",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "804-451-9935",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "2016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.