| Fccr Southlake | |
|
905 Southlake Blvd Suites A & C North Chesterfield VA 23236-3955 | |
| (804) 354-1996 | |
| Not Available |
| Full Name | Fccr Southlake |
|---|---|
| Speciality | Clinic/center - Methadone |
| Location | 905 Southlake Blvd, North Chesterfield, Virginia |
| Authorized Official Name and Position | Robyn Tanis (EXEC DIR CONTRACT MANAGEMENT) |
| Authorized Official Contact | 8565338762 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fccr Southlake 1317 Route 73 Mount Laurel NJ 08054-2202 Ph: (856) 533-8762 | Fccr Southlake 905 Southlake Blvd Suites A & C North Chesterfield VA 23236-3955 Ph: (804) 354-1996 |
| NPI Number | 1558874461 |
|---|---|
| Provider Enumeration Date | 11/14/2017 |
| Last Update Date | 11/21/2023 |
| Certification Date | 11/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558874461 | NPI | - | NPPES |
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