Healthcare Provider Details

I. General information

NPI: 1447627179
Provider Name (Legal Business Name): L&R OF CHESTERFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 HARBOUR PARK DR STE B
MIDLOTHIAN VA
23112-2135
US

IV. Provider business mailing address

5912 HARBOUR PARK DR STE B
MIDLOTHIAN VA
23112-2135
US

V. Phone/Fax

Practice location:
  • Phone: 804-921-6359
  • Fax: 804-744-2961
Mailing address:
  • Phone: 804-921-6359
  • Fax: 804-744-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberOLIS2235
License Number StateVA

VIII. Authorized Official

Name: MRS. LISA LYNNE NASHETTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-921-6359