Western Tidewater Community Services Board
NPI 1689928996 · Intellectual Disabilities Intermediate Care Facility · Suffolk, VA
Western Tidewater Community Services Board is a Intellectual Disabilities Intermediate Care Facility organization in Suffolk, VA (NPI 1689928996).
Provider details
- NPI number
- 1689928996
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Demetrios Peratsakis, Executive Director(757) 255-7133
- License
- 08401005 (VA)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Other name
- Vince'S Place/Chase'S Way Icf/Iid
Registry dates
- Enumerated
- 2012-11-08
- Last updated
- 2024-01-29
- Certified
- 2024-01-29
Frequently asked questions
- What is Western Tidewater Community Services Board's NPI number?
- Western Tidewater Community Services Board's National Provider Identifier (NPI) is 1689928996, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Western Tidewater Community Services Board?
- Western Tidewater Community Services Board is classified in the NPPES registry as Intellectual Disabilities Intermediate Care Facility (Nursing & Custodial Care Facilities).
- Where is Western Tidewater Community Services Board located?
- Western Tidewater Community Services Board's practice location on file with NPPES is 4373 Pruden Boulevard, Suffolk, VA 23434.
- What is Western Tidewater Community Services Board's phone number?
- The practice phone number listed in the NPPES registry for Western Tidewater Community Services Board is (757) 255-7127.
- Who is the authorized official for Western Tidewater Community Services Board?
- The authorized official listed on Western Tidewater Community Services Board's NPPES record is Demetrios Peratsakis, Executive Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Western Tidewater Community Services Board's NPI active?
- Yes — Western Tidewater Community Services Board's NPI (1689928996) is active in the NPPES registry as of the last update on 2024-01-29.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.