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General NPI Number Information
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NPI Number | 1629840632
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Entity Type | Organization
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Legal Business Name | EUPHORIA RESIDENTIAL HOME LLC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 941 19TH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-5334
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Country | US
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Telephone | 757-329-4136
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Fax |
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Provider Business Mailing Address
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Address Line | 941 19TH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-5334
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Country | US
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Telephone | 757-329-4136
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ERRIKA LOWE
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Credential |
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Telephone | 757-329-4136
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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 |
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