Healthcare Provider Details

I. General information

NPI: 1750618039
Provider Name (Legal Business Name): URBAN ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2009
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E 15TH ST
RICHMOND VA
23224-3810
US

IV. Provider business mailing address

116 E 15TH ST
RICHMOND VA
23224-3810
US

V. Phone/Fax

Practice location:
  • Phone: 804-230-2337
  • Fax:
Mailing address:
  • Phone: 804-230-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number1316-14-001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number1316-14-001
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1316-14-001
License Number StateVA

VIII. Authorized Official

Name: MR. DAVID HAWKES
Title or Position: CAO
Credential:
Phone: 804-230-2337