Healthcare Provider Details

I. General information

NPI: 1336531979
Provider Name (Legal Business Name): INDPENDENT VOICES ADULT LIVINGLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 NEWTOWN RD SUITE B2-100
VA BEACH VA
23462-2406
US

IV. Provider business mailing address

1309 YEADON RD
CHESAPEAKE VA
23324-3751
US

V. Phone/Fax

Practice location:
  • Phone: 757-729-0480
  • Fax:
Mailing address:
  • Phone: 757-729-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RENOVIA DEATICH WHITFIED
Title or Position: CEO
Credential:
Phone: 757-729-0480