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General NPI Number Information
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NPI Number | 1528508264
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Entity Type | Organization
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Legal Business Name | FAMILY EXTENSIONS, LLC
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 779 LESNER AVE
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City | NORFOLK
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State | VA
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Zip | 23518-2503
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Country | US
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Telephone | 757-822-6337
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Fax | 888-704-5051
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Provider Business Mailing Address
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Address Line | 779 LESNER AVE
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City | NORFOLK
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State | VA
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Zip | 23518-2503
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Country | US
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Telephone | 757-822-6337
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Fax | 888-704-5051
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Authorized Official
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Title or Position | CEO
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Name | SHERNITA ARTIS
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Credential |
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Telephone | 757-822-6337
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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 | 2030-01-001
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License Number State | VA
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