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General NPI Number Information
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NPI Number | 1285930198
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Entity Type | Organization
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Legal Business Name | COMMUNITY OPTIONS, LLC
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 1906 LAIGH RD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2629
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Country | US
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Telephone | 757-560-3898
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Fax | 757-273-6400
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Provider Business Mailing Address
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Address Line | 916 GREAT MARSH AVE
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0662
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Country | US
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Telephone | 757-560-3898
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Fax | 757-273-6400
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Authorized Official
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Title or Position | CEO/PROGRAM ADMIN
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Name | MR. RONNIE BROWN
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Credential |
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Telephone | 757-560-3898
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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 | 1484
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License Number State | VA
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