Healthcare Provider Details

I. General information

NPI: 1013865229
Provider Name (Legal Business Name): POWERFUL LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14705 GATEWOOD RD
DEWITT VA
23840-2815
US

IV. Provider business mailing address

2405 DOVERCOURT DR
MIDLOTHIAN VA
23113-6420
US

V. Phone/Fax

Practice location:
  • Phone: 804-441-1802
  • Fax:
Mailing address:
  • Phone: 804-441-1802
  • 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: LORI KISTNER
Title or Position: OWNER
Credential: PCA, MA
Phone: 804-441-1802