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General NPI Number Information
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NPI Number | 1750566345
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Entity Type | Organization
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Legal Business Name | BATTLEFIELD LIGHTHOUSE SERVICES CORP.
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 8659 STAPLES MILL RD
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City | RICHMOND
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State | VA
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Zip | 23228-2718
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Country | US
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Telephone | 804-523-7283
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Fax |
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Provider Business Mailing Address
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Address Line | 8659 STAPLES MILL RD PO BOX 28289
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City | RICHMOND
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State | VA
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Zip | 23228-2718
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Country | US
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Telephone | 804-523-7283
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SEBASTIAN SYMEONIDES
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Credential |
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Telephone | 804-523-7283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | SS35907
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License Number State | VA
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