Healthcare Provider Details

I. General information

NPI: 1235461070
Provider Name (Legal Business Name): DUBIES LOVE RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALMEDA AVE STE 114
NORFOLK VA
23513-2403
US

IV. Provider business mailing address

2500 ALMEDA AVE STE 114
NORFOLK VA
23513-2403
US

V. Phone/Fax

Practice location:
  • Phone: 757-408-0718
  • Fax:
Mailing address:
  • Phone: 757-408-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number1339
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateVA

VIII. Authorized Official

Name: RHONDA ANN TAYLOR
Title or Position: CEO
Credential:
Phone: 757-718-7680