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General NPI Number Information
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NPI Number | 1902261159
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Entity Type | Organization
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Legal Business Name | GUTHER LEE'S RESIDENTIAL SERVICES, LLC
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 5 LOUDER CT
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3718
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Country | US
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Telephone | 757-967-8513
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Fax |
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Provider Business Mailing Address
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Address Line | 8177 DICKINSON CT
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City | MANASSAS
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State | VA
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Zip | 20111-2584
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Country | US
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Telephone | 703-470-8391
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBERT DEBNAM
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Credential |
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Telephone | 703-470-8391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 236201001
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 236201001
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 236201001
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 236201001
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License Number State | VA
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Taxonomy #5
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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 | 236201001
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License Number State | VA
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