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General NPI Number Information
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NPI Number | 1750698189
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Entity Type | Organization
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Legal Business Name | SURE FOUNDATIONS, LLC
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 1210 MARSH ST
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City | NORFOLK
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State | VA
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Zip | 23523-1767
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Country | US
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Telephone | 757-237-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 MARSH ST
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City | NORFOLK
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State | VA
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Zip | 23523-1767
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Country | US
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Telephone | 757-237-0234
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL
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Name | MRS. ALBERTA REID
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Credential | MSW, CFCS-HDFS
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Telephone | 757-237-0235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 214061
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License Number State | VA
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