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General NPI Number Information
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NPI Number | 1366188914
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Entity Type | Organization
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Legal Business Name | FULFILLMENTS FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 10/29/2023
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Provider Practice Location Address
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Address Line | 432 MAYCOX ST
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City | PETERSBURG
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State | VA
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Zip | 23805-2758
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Country | US
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Telephone | 804-721-8699
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Fax | 804-800-4381
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Provider Business Mailing Address
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Address Line | 432 MAYCOX ST
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City | PETERSBURG
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State | VA
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Zip | 23805-2758
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Country | US
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Telephone | 804-721-8699
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Fax | 804-800-4381
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Authorized Official
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Title or Position | CEO
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Name | DAJUAN ARKALLE HOOPER
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Credential |
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Telephone | 804-721-8699
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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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