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General NPI Number Information
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NPI Number | 1992120018
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Entity Type | Organization
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Legal Business Name | ZOE HOUSE, LLC
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 4936 BLACK OAK RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23237-2139
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Country | US
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Telephone | 804-608-9631
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26432
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City | RICHMOND
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State | VA
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Zip | 23260-6432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. TARVARIS J MCCOY
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Credential |
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Telephone | 804-381-2501
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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 | 2079-01-001
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License Number State | VA
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