Healthcare Provider Details

I. General information

NPI: 1588737837
Provider Name (Legal Business Name): SAVANNAH'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 WOODSIDE CT
HOPEWELL VA
23860-4021
US

IV. Provider business mailing address

PO BOX 14
HOPEWELL VA
23860-0014
US

V. Phone/Fax

Practice location:
  • Phone: 804-452-2170
  • Fax:
Mailing address:
  • Phone: 804-452-2170
  • Fax: 804-452-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number664-14-001
License Number StateVA

VIII. Authorized Official

Name: EUNICE M BLACKWELL
Title or Position: OWNER
Credential:
Phone: 804-452-2170