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General NPI Number Information
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NPI Number | 1962852343
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Entity Type | Organization
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Legal Business Name | LUMEN CHRISTI HOME OF VIRGINIA CORPORATION
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 177 S PLAZA TRL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5557
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Country | US
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Telephone | 757-228-5893
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Fax | 757-282-6374
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Provider Business Mailing Address
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Address Line | 177 S PLAZA TRL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5557
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Country | US
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Telephone | 757-228-5893
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Fax | 757-282-6374
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | FRANCIS IRIA AIKHU
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Credential |
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Telephone | 757-228-5893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 2280
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License Number State | VA
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