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General NPI Number Information
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NPI Number | 1023188620
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Entity Type | Organization
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Legal Business Name | STRONG FOUNDATION YOUTH INITIATIVE, LLC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 6001 LAKESIDE AVE SUITE 20
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City | RICHMOND
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State | VA
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Zip | 23228-5735
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Country | US
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Telephone | 804-283-6194
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 LAKESIDE AVE SUITE 20
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City | RICHMOND
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State | VA
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Zip | 23228-5735
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Country | US
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Telephone | 804-283-6194
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT LESLIE ASHFORD
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Credential | B.S., QMHP
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Telephone | 804-283-6194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 806
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License Number State | VA
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