Healthcare Provider Details

I. General information

NPI: 1144034026
Provider Name (Legal Business Name): LYFE COMPREHENSIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 EARLY SETTLERS RD
NORTH CHESTERFIELD VA
23235-3832
US

IV. Provider business mailing address

2223 EARLY SETTLERS RD
NORTH CHESTERFIELD VA
23235-3832
US

V. Phone/Fax

Practice location:
  • Phone: 804-938-4766
  • Fax:
Mailing address:
  • Phone: 804-938-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND BREWSTER GRAVES IV
Title or Position: CEO
Credential:
Phone: 804-938-4766