Healthcare Provider Details

I. General information

NPI: 1770499386
Provider Name (Legal Business Name): LAVENDER HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9704 ESMONT RD
RICHMOND VA
23228-1210
US

IV. Provider business mailing address

PO BOX 7989
RICHMOND VA
23223-0189
US

V. Phone/Fax

Practice location:
  • Phone: 804-253-3731
  • Fax:
Mailing address:
  • Phone: 804-253-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SABRINA GREGORY HANCOCK
Title or Position: OWNER
Credential: DNP, FNP-BC, PMHNP-B
Phone: 804-253-3731