Healthcare Provider Details

I. General information

NPI: 1447717079
Provider Name (Legal Business Name): CITAGROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 CASTLEWELLAN DR
CHESTER VA
23836-2904
US

IV. Provider business mailing address

13355 CASTLEWELLAN DR
CHESTER VA
23836-2904
US

V. Phone/Fax

Practice location:
  • Phone: 804-720-5164
  • Fax:
Mailing address:
  • Phone: 804-720-5164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. YINKA LAWAL
Title or Position: MD
Credential:
Phone: 804-720-5164