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General NPI Number Information
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NPI Number | 1790094597
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Entity Type | Organization
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Legal Business Name | MIDDLETON GEE COMMUNITY GROUP HOME, LLC
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 1634 HUNGARY RD
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City | RICHMOND
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State | VA
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Zip | 23228-2314
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Country | US
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Telephone | 804-377-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 1634 HUNGARY RD
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City | RICHMOND
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State | VA
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Zip | 23228-2314
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Country | US
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Telephone | 804-377-8440
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. BETTY D LEWIS
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Credential |
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Telephone | 804-377-8440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1437-01-001
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License Number State | VA
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