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General NPI Number Information
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NPI Number | 1194759100
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Entity Type | Organization
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Legal Business Name | OLIVIA'S GROUP HOME LONCHMNS, INC.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7501 MOSS SIDE AVE
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City | RICHMOND
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State | VA
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Zip | 23227-1837
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Country | US
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Telephone | 804-266-3897
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Fax | 804-264-1510
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Provider Business Mailing Address
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Address Line | 7501 MOSS SIDE AVE
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City | RICHMOND
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State | VA
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Zip | 23227-1837
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Country | US
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Telephone | 804-266-3897
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Fax | 804-264-1510
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. LILLIAN JACQUELINE MITCHELL
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Credential | M. ED
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Telephone | 804-266-3897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 531
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License Number State | VA
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