OrganizationActive
Western Tidewater Community Services Board
NPI 1922041177 · Intellectual Disabilities Intermediate Care Facility · Suffolk, VA
Provider details
- NPI number
- 1922041177
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Demetrios Peratsakis, Executive Director(757) 966-2805
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
1406 Blythewood Ln
Suffolk, VA 23434-2804
Phone: (757) 255-7127
Approximate (ZIP-level) locationGet directions
Mailing address
7025 Harbour View Blvd Ste 119
Suffolk, VA 23435-2762
Registry dates
- Enumerated
- 2006-06-14
- Last updated
- 2023-02-28
- Certified
- 2023-02-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.