Intensive Community Outreach Services

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

07313155018008081414 Issued in VA

Legal business name

INTENSIVE COMMUNITY OUTREACH SERVICES

Practice address

1524 Merrimac Trail
Suite J
Wiliamsburg, VA 23815

Phone

(804) 521-4327

NPI assigned

May 18, 2009

Last updated

May 18, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bernard Lamont Heyward

Title

President

Phone

(804) 551-4155

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Intensive Community Outreach Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Intensive Community Outreach Services LLC

  • Preferred Provider Organization
  • Richmond, VA
  • NPI 1639335987
  NPD tax ID

Locations

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

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242604800000",
    "number": "1548495708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 E. FRANKLIN STREET",
            "address_2": "SUITE 516",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23219",
            "telephone_number": "804-521-4327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 MERRIMAC TRAIL",
            "address_2": "SUITE J",
            "city": "WILIAMSBURG",
            "state": "VA",
            "postal_code": "23815",
            "telephone_number": "804-521-4327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENSIVE COMMUNITY OUTREACH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-18",
        "last_updated": "2009-05-18",
        "status": "A",
        "authorized_official_last_name": "HEYWARD",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-551-4155",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "VA",
            "license": "07313155018008081414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639335987",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; 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.