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General NPI Number Information
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NPI Number | 1487837522
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Entity Type | Organization
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Legal Business Name | COMMUNITY GROUP HOMES, LLC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 3246 DUNKIRK AVE
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City | NORFOLK
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State | VA
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Zip | 23509-1908
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Country | US
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Telephone | 757-625-2220
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Fax |
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Provider Business Mailing Address
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Address Line | 3246 DUNKIRK AVE
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City | NORFOLK
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State | VA
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Zip | 23509-1908
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Country | US
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Telephone | 757-625-2220
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Fax |
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Authorized Official
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Title or Position | GROUP HOMES COORDINATOR
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Name | MRS. SONDRE FLEMING
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Credential |
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Telephone | 757-825-2220
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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 |
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License Number State | VA
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