=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134832611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A PLACE OF PEACE RESIDENTIAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2022
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 BANYAN DR
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-5236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-204-5462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15000 POTOMAC TOWN PL # 264
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22191-6586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-204-5462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROGRAM DIRECTOR
-----------------------------------------------------
Name | CAMILLE L. BROWN
-----------------------------------------------------
Credential | PROGRAM DIRECTOR
-----------------------------------------------------
Telephone | 757-215-5794
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------