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General NPI Number Information
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NPI Number | 1659970309
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Entity Type | Organization
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Legal Business Name | FAITHFUL FRIENDS FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 1040 7TH ST
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City | PETERSBURG
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State | VA
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Zip | 23803-5259
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Country | US
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Telephone | 804-661-2096
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Fax | 804-823-8077
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Provider Business Mailing Address
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Address Line | 20814 TRUTH DR
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23803-1830
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Country | US
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Telephone | 804-661-2096
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Fax | 804-823-8077
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Authorized Official
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Title or Position | CEO
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Name | RAYMOND BRADLEY III
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Credential | QDDP
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Telephone | 804-661-2096
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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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