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General NPI Number Information
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NPI Number | 1891863973
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Entity Type | Organization
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Legal Business Name | THERESA'-VENIA, LLC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1536 CENTRE AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23704-6802
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Country | US
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Telephone | 757-967-9545
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Fax |
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Provider Business Mailing Address
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Address Line | 4107 PORTSMOUTH BLVD 101-35
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City | CHESAPEAKE
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State | VA
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Zip | 23321-2140
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Country | US
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Telephone | 757-513-2074
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR EXECUTIVE DIRECTOR
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Name | MRS. LEOLIA BROWN
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Credential |
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Telephone | 757-513-2074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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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 | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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