Healthcare Provider Details

I. General information

NPI: 1952621526
Provider Name (Legal Business Name): A NEW YOU TRANSITIONAL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 HACKNEY RD
RICHMOND VA
23234-4597
US

IV. Provider business mailing address

PO BOX 73404
RICHMOND VA
23235-8041
US

V. Phone/Fax

Practice location:
  • Phone: 804-275-9115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES GREENE
Title or Position: CEO
Credential:
Phone: 804-439-0486