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General NPI Number Information
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NPI Number | 1649813478
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Entity Type | Organization
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Legal Business Name | ALTRUISTIC LIFE SERVICES, INC.
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 2443 PARKVIEW AVE
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City | PETERSBURG
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State | VA
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Zip | 23803-4811
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Country | US
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Telephone | 804-608-9759
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Fax |
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Provider Business Mailing Address
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Address Line | 4222 BONNIEBANK RD STE 203
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-6632
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Country | US
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Telephone | 804-608-9759
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Fax | 833-252-0862
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Authorized Official
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Title or Position | CEO
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Name | RENO LEGROS
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Credential |
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Telephone | 804-608-9759
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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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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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