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General NPI Number Information
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NPI Number | 1881931095
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Entity Type | Organization
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Legal Business Name | LANDMARK HAVEN, INC.
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 1233 HICKORY CREEK RD
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City | GLADYS
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State | VA
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Zip | 24554-2346
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Country | US
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Telephone | 434-534-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 HICKORY CREEK
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City | GLADYS
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State | VA
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Zip | 24554
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Country | US
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Telephone | 434-534-4471
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEBORAH L BUTLER
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Credential |
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Telephone | 434-534-4471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | VA
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