Healthcare Provider Details

I. General information

NPI: 1255173852
Provider Name (Legal Business Name): NATURAL NUBIAN & CO. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 S MILITARY HWY
CHESAPEAKE VA
23320-5987
US

IV. Provider business mailing address

913 RILEY DR
CHESAPEAKE VA
23322-7420
US

V. Phone/Fax

Practice location:
  • Phone: 757-383-9992
  • Fax:
Mailing address:
  • Phone: 757-383-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. TYLICIA T JONES
Title or Position: CEO
Credential: B.S.
Phone: 757-769-3260