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General NPI Number Information
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NPI Number | 1790226215
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Entity Type | Organization
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Legal Business Name | B & R SUPPORTIVE LIVING, LLC
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 5752 ANDREA DR NORFOLK, VA 23518
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City | NORFOLK
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State | VA
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Zip | 23518-5743
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Country | US
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Telephone | 757-367-1961
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Fax | 757-499-6323
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Provider Business Mailing Address
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Address Line | 5752 ANDREA DR NORFOLK, VA 23518
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City | NORFOLK
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State | VA
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Zip | 23518-5743
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Country | US
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Telephone | 757-367-1961
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Fax | 757-499-6323
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Authorized Official
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Title or Position | OWNER
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Name | MRS. WYNTER WYNETTE RIDDICK
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Credential | CEO
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Telephone | 757-367-1961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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