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General NPI Number Information
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NPI Number | 1144526955
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Entity Type | Organization
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Legal Business Name | QUALITY LIVING OF HAMPTON ROADS,LLC
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 1109 FREEDOM AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3219
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Country | US
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Telephone | 757-724-2432
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Fax | 757-399-8879
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Provider Business Mailing Address
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Address Line | 1506 PARKER AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23704-4426
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Country | US
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Telephone | 757-724-2432
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Fax | 757-399-8879
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ANN MARIE BANKS
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Credential |
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Telephone | 757-724-2432
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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 | 144401001
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License Number State | VA
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