OrganizationActive
Western Tidewater Community Services Board
NPI 1689928996 · Intellectual Disabilities Intermediate Care Facility · Suffolk, VA
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
Practice location
4373 Pruden Boulevard
Suffolk, VA 23434
Phone: (757) 255-7127
Fax: (757) 255-7139
Approximate (ZIP-level) locationGet directions
Mailing address
7025 Harbour View Blvd Ste 119
Suffolk, VA 23435-2762
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
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.