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General NPI Number Information
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NPI Number | 1710525746
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Entity Type | Organization
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Legal Business Name | 1850 WEST ENTERPRISE
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Dates
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Enumeration Date | 12/20/2019
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 1610 SPECTATOR ST
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3331
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Country | US
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Telephone | 757-240-7970
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Fax |
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Provider Business Mailing Address
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Address Line | 3007 DELAWARE XING
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-3112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | TIFFANY PRICE
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Credential |
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Telephone | 757-348-5548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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