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General NPI Number Information
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NPI Number | 1255143681
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Entity Type | Organization
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Legal Business Name | WOODRUFF RESIDENTIAL LLC
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 9447 HILDA AVE
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23237-3440
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Country | US
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Telephone | 804-402-1894
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Fax |
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Provider Business Mailing Address
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Address Line | 1924 WHITE MOUNTAIN DR
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City | CHESTER
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State | VA
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Zip | 23836-3008
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Country | US
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Telephone | 804-402-1894
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHAVONNE RENEE JACKSON
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Credential | NP
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Telephone | 804-402-1894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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