Healthcare Provider Details

I. General information

NPI: 1700795374
Provider Name (Legal Business Name): DMR ANGEL SPONSORED RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LAKE SPEIGHT DR
SUFFOLK VA
23434-6029
US

IV. Provider business mailing address

1530 LAKE SPEIGHT DR
SUFFOLK VA
23434-6029
US

V. Phone/Fax

Practice location:
  • Phone: 757-334-0474
  • Fax: 757-934-2042
Mailing address:
  • Phone: 757-334-0474
  • Fax: 757-934-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOANNE CALVIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-334-0474