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General NPI Number Information
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NPI Number | 1215883897
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Entity Type | Organization
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Legal Business Name | RE-CREATION RESIDENTIAL GROUP HOME SERVICES LLC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 1303 FILLMORE ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-6417
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Country | US
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Telephone | 215-252-2996
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Fax | 703-563-2136
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Provider Business Mailing Address
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Address Line | 39 RIVERVIEW AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23704-1916
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Country | US
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Telephone | 215-252-2996
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAVANDA FLORES
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Credential |
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Telephone | 215-252-2996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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