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General NPI Number Information
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NPI Number | 1609029172
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Entity Type | Organization
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Legal Business Name | KIDS 4 SUCCESS, LLC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 641 BIRCH AVE
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City | HAMPTON
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State | VA
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Zip | 23661-1719
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Country | US
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Telephone | 754-246-8506
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Fax |
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Provider Business Mailing Address
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Address Line | 641 BIRCH AVE
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City | HAMPTON
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State | VA
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Zip | 23661-1719
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Country | US
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Telephone | 754-246-8506
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TELOVE LADAWN BROWN
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Credential | RN
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Telephone | 757-818-4352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 1052-14-001
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License Number State | VA
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