Healthcare Provider Details

I. General information

NPI: 1689595522
Provider Name (Legal Business Name): THE PASSION REGIMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14524 GLENMORGAN DR
CHESTER VA
23831-6638
US

IV. Provider business mailing address

14524 GLENMORGAN DR
CHESTER VA
23831-6638
US

V. Phone/Fax

Practice location:
  • Phone: 804-484-4347
  • Fax:
Mailing address:
  • Phone: 804-484-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KESHAUN D SMOOT
Title or Position: CEO
Credential: MSW, LMHP-S
Phone: 804-484-4347