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General NPI Number Information
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NPI Number | 1093110074
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Entity Type | Organization
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Legal Business Name | EPIPHANY II UNITY HOUSE LLC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 143 UNITY RD
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City | KENBRIDGE
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State | VA
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Zip | 23944-3902
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Country | US
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Telephone | 804-676-4847
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Fax |
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Provider Business Mailing Address
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Address Line | 7707 JARWIN LN
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City | RICHMOND
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State | VA
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Zip | 23231-7159
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Country | US
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Telephone | 804-837-5706
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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. RONNIE LEE PATTERSON JR.
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Credential |
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Telephone | 804-837-5706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | VA
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