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General NPI Number Information
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NPI Number | 1700795374
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Entity Type | Organization
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Legal Business Name | DMR ANGEL SPONSORED RESIDENTIAL SERVICES LLC
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 1530 LAKE SPEIGHT DR
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City | SUFFOLK
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State | VA
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Zip | 23434-6029
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Country | US
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Telephone | 757-334-0474
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Fax | 757-934-2042
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Provider Business Mailing Address
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Address Line | 1530 LAKE SPEIGHT DR
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City | SUFFOLK
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State | VA
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Zip | 23434-6029
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Country | US
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Telephone | 757-334-0474
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Fax | 757-934-2042
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOANNE CALVIE
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Credential |
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Telephone | 757-334-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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