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General NPI Number Information
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NPI Number | 1275699076
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Entity Type | Organization
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Legal Business Name | WINDSOR MANOR TRAINING HOME ADULT MIN.
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1010 4TH ST
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City | LYNCHBURG
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State | VA
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Zip | 24504-2806
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Country | US
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Telephone | 434-385-4799
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Fax | 434-847-3230
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Provider Business Mailing Address
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Address Line | 1104 ARDMORE DR
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City | LYNCHBURG
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State | VA
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Zip | 24501-2234
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Country | US
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Telephone | 434-385-4799
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Fax | 434-847-3230
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. STEPHANIE DENISE MASSIE
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Credential |
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Telephone | 343-847-1219
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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 | 0100059631
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License Number State | VA
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