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General NPI Number Information
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NPI Number | 1114665825
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Entity Type | Organization
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Legal Business Name | ALD GROUPS LLC
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 132 LAKESIDE DR
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-1604
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Country | US
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Telephone | 323-497-7039
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Fax |
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Provider Business Mailing Address
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Address Line | 206 TEMPLE AVE STE 2
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CIO
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Name | DR. PRINCESS CHINYERE HALLIDAY ENYIUKWU
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Credential | PHD
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Telephone | 323-497-7039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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