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General NPI Number Information
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NPI Number | 1902028251
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Entity Type | Organization
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Legal Business Name | JAMES BENTLEY TREATMENT PROGRAM
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1020 LECKIE STREET
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City | PORTSMOUTH
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State | VA
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Zip | 23704
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Country | US
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Telephone | 757-399-3025
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Fax | 757-673-7965
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Provider Business Mailing Address
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Address Line | P.O. BOX 243
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City | PORTSMOUTH
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State | VA
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Zip | 23705
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Country | US
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Telephone | 757-399-3035
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Fax | 757-673-7965
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA PINNOCK
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Credential |
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Telephone | 757-399-3025
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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 | 78214001
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License Number State | VA
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