Healthcare Provider Details

I. General information

NPI: 1114814837
Provider Name (Legal Business Name): THE LEXX HOUSE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PROFESSIONAL PKWY STE 1530
YORKTOWN VA
23693-4335
US

IV. Provider business mailing address

105 PROFESSIONAL PKWY STE 1530
YORKTOWN VA
23693-4335
US

V. Phone/Fax

Practice location:
  • Phone: 757-715-6808
  • Fax:
Mailing address:
  • Phone: 757-715-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE TYLER
Title or Position: OWNER
Credential:
Phone: 757-798-0954