Healthcare Provider Details

I. General information

NPI: 1427419035
Provider Name (Legal Business Name): POWERHOUSE UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N 25TH ST APT 260
RICHMOND VA
23223-7564
US

IV. Provider business mailing address

418 N 25TH ST APT 260
RICHMOND VA
23223
US

V. Phone/Fax

Practice location:
  • Phone: 240-455-2085
  • Fax:
Mailing address:
  • Phone: 240-455-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TAYLA RHINE
Title or Position: CO-CEO
Credential: M.S.
Phone: 240-455-2085