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General NPI Number Information
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NPI Number | 1265970263
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Entity Type | Organization
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Legal Business Name | GHR CENTER FOR OPIOID ADDICTION TREATMENT AND RECOVERY LLC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 850 TIDEWATER DR STE A
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City | NORFOLK
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State | VA
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Zip | 23504-3300
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Country | US
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Telephone | 757-333-6992
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Fax |
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Provider Business Mailing Address
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Address Line | 850 TIDEWATER DR STE A
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City | NORFOLK
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State | VA
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Zip | 23504-3300
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Country | US
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Telephone | 757-209-2776
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | SHANI KIRVIN
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Credential |
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Telephone | 757-333-6992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State | VA
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