Healthcare Provider Details

I. General information

NPI: 1891863973
Provider Name (Legal Business Name): THERESA'-VENIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 CENTRE AVE
PORTSMOUTH VA
23704-6802
US

IV. Provider business mailing address

4107 PORTSMOUTH BLVD 101-35
CHESAPEAKE VA
23321-2140
US

V. Phone/Fax

Practice location:
  • Phone: 757-967-9545
  • Fax:
Mailing address:
  • Phone: 757-513-2074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEOLIA BROWN
Title or Position: ADMINISTRATOR EXECUTIVE DIRECTOR
Credential:
Phone: 757-513-2074