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General NPI Number Information
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NPI Number | 1891008710
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Entity Type | Organization
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Legal Business Name | NADIYA HOUSE, LLC
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 123 S CHAPPELL ST
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City | PETERSBURG
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State | VA
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Zip | 23803-3910
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Country | US
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Telephone | 804-919-1826
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 146
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-0146
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Country | US
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Telephone | 804-862-2340
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Fax | 804-862-2340
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHIRLEY HARTENSE SCOTT
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Credential |
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Telephone | 804-862-2340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 1265
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License Number State | VA
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