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General NPI Number Information
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NPI Number | 1881833432
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Entity Type | Organization
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Legal Business Name | POWERLINE COMMUNITY DEVELOPMENT CORP.
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 610 BROOKE ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-1506
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Country | US
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Telephone | 757-827-6937
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Fax | 757-827-6940
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Provider Business Mailing Address
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Address Line | 6148 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-1557
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Country | US
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Telephone | 757-827-6937
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Fax | 757-827-6940
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ROSE ELAM
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Credential |
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Telephone | 757-827-6937
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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 |
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License Number State | VA
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