Healthcare Provider Details

I. General information

NPI: 1174431043
Provider Name (Legal Business Name): AN IDEAL LIVING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 NEWTOWN RD STE B-1
VIRGINIA BEACH VA
23462-2412
US

IV. Provider business mailing address

154 NEWTOWN RD STE B-1
VIRGINIA BEACH VA
23462-2412
US

V. Phone/Fax

Practice location:
  • Phone: 757-339-8155
  • Fax:
Mailing address:
  • Phone: 757-339-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: JASMINE UNIQUE WYNN
Title or Position: DIRECTOR
Credential:
Phone: 757-339-8155