MEDICARE: R&R RESIDENTIAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1760952592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R&R RESIDENTIAL, LLC

Provider Business Mailing Address
First Line	:	918 VIRGILINA AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503
Country	:	US
Telephone Number	:	757-672-8237
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 SEWELLS POINT RD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513
Country	:	US
Telephone Number	:	757-672-8237
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROGRAM DIRECTOR
Name	:	MRS. RYAN TAYLOR STORES
Credential	:
Telephone Number	:	757-672-8237

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	12/05/2018

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