Healthcare Provider Details

I. General information

NPI: 1760245641
Provider Name (Legal Business Name): URBAN LIFE SUBSTANCE ABUSE AND OUTPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 B 21ST STREET W
NORFOLK VA
23517
US

IV. Provider business mailing address

3217 CEDAR LN
PORTSMOUTH VA
23703-4101
US

V. Phone/Fax

Practice location:
  • Phone: 757-945-7527
  • Fax:
Mailing address:
  • Phone: 757-945-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LEON BATTLE
Title or Position: OWNER
Credential:
Phone: 757-945-7527