VINCE'S PLACE/CHASE'S WAY ICF/IID
NPI 1689928996
Intermediate Care Facility, Intellectual Disabilities in Suffolk, VA

Q: What is Western Tidewater Community Services Board's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Active since November 08, 2012

4373 PRUDEN BOULEVARD, SUFFOLK, VA 23434(757) 255-7127(757) 255-7139 Get Directions Write a Review

NPPES record last updated: January 29, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Vince's Place/chase's Way Icf/iid NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VINCE'S PLACE/CHASE'S WAY ICF/IID (NPI 1689928996) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Suffolk, Virginia and active in the NPI registry since November 2012. The organization lists Demetrios Peratsakis, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1689928996

Entity TypeOrganization

Primary Taxonomy315P00000X

Legal Business NameWESTERN TIDEWATER COMMUNITY SERVICES BOARD

Location Address4373 PRUDEN BOULEVARDSuffolk, VA 23434

Mailing Address7025 Harbour View Blvd Ste 119Suffolk, VA 23435-2762 · (757) 966-2805 · Fax (757) 673-2586

Phone(757) 255-7127

Fax(757) 255-7139

Organization SubpartNo

Authorized OfficialDemetrios PeratsakisExecutive Director · (757) 255-7133

Enumeration DateNovember 8, 2012

Last NPPES UpdateJanuary 29, 2024

NPPES CertifiedJanuary 29, 2024

✔ NPI 1689928996 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities

Taxonomy Code315P00000X

License✔ Licensed in VA · 08401005

Definition

An intermediate care facility providing services for individuals with intellectual disabilities.

4373 PRUDEN BOULEVARD, Suffolk, VA 23434

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Other Names 1

Other NameVince's Place/chase's Way Icf/iid

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Western Tidewater Community Services Board's NPI number?

The NPI number for Western Tidewater Community Services Board is 1689928996. It was assigned to this organization in the NPPES registry on November 8, 2012. The provider is also known as Vince's Place/Chase's Way Icf/Iid.

Where is Western Tidewater Community Services Board located?

Western Tidewater Community Services Board is located at 4373 Pruden Boulevard, Suffolk, VA 23434. The listed phone number is (757) 255-7127.

What is Western Tidewater Community Services Board's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

When was this NPI record last updated?

The NPPES record for Western Tidewater Community Services Board was last updated on January 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.