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General NPI Number Information
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NPI Number | 1326969205
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Entity Type | Organization
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Legal Business Name | STILL WATERS SUPPORTIVE LIVING, LLC
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 1550 DARREN CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3102
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Country | US
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Telephone | 757-447-0885
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Fax |
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Provider Business Mailing Address
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Address Line | 5450 SCHOLARSHIP DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-7336
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Country | US
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Telephone | 757-798-9102
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KAYLA WARE
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Credential | MHI
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Telephone | 757-798-9102
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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 |
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License Number State |
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