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General NPI Number Information
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NPI Number | 1679639546
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Entity Type | Organization
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Legal Business Name | THE SIERRAS LIFE, LLC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2211 E PARHAM RD
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City | RICHMOND
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State | VA
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Zip | 23228-2238
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Country | US
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Telephone | 804-515-5946
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Fax |
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Provider Business Mailing Address
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Address Line | 242 HILLCREST DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4010
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Country | US
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Telephone | 540-898-0851
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Fax | 540-898-6531
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KENNETH E. BROWN
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Credential |
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Telephone | 540-898-0851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 365-02-006
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License Number State | VA
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