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General NPI Number Information
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NPI Number | 1003141227
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Entity Type | Organization
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Legal Business Name | JAMES BENTLEY TREATMENT PROGRAM
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 10/06/2009
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Provider Practice Location Address
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Address Line | 1020 LECKIE ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-1904
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Country | US
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Telephone | 757-399-4742
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Fax | 757-673-7965
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Provider Business Mailing Address
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Address Line | 1020 LECKIE ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-1904
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Country | US
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Telephone | 757-399-4742
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Fax | 757-673-7965
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Authorized Official
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Title or Position | DIRECTOR
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Name | SANDRA PINNOCK
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Credential |
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Telephone | 757-399-4742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 78205001
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License Number State | VA
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