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General NPI Number Information
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NPI Number | 1710757208
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Entity Type | Organization
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Legal Business Name | YOUNIVERSAL RESIDENTIAL CARE, LLC
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 809 LIVE OAK DR STE 27
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2600
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Country | US
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Telephone | 757-904-1119
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Fax | 757-299-7836
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Provider Business Mailing Address
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Address Line | 809 LIVE OAK DR STE 27
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2600
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Country | US
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Telephone | 757-904-1119
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Fax | 757-299-7836
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Authorized Official
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Title or Position | CEO
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Name | IESHA ANDREWS
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Credential | RN
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Telephone | 757-237-1098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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