Annzetta'S Therapeutic Home For Boys, LLC
Community Based Residential Treatment Facility, Mental Illness in Petersburg, VA. Organization (NPI-2).
NPI number1063609659
StatusActive
Last updated in NPPESOct 25, 2007
Details
- NPI
- 1063609659
- Entity type
- Organization (NPI-2)
- Legal business name
- Annzetta'S Therapeutic Home For Boys, LLC
- Organization subpart
- No
- Enumeration date
- Sep 27, 2007
- Last updated
- Oct 25, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | – | – | Yes |
Practice location
1834 Buckner StPetersburg, VA 23805-1705
Phone 804-863-2661
Mailing address
1834 Buckner StPetersburg, VA 23805-1705
Phone 804-863-2661
Authorized official
Mary Emma Harris
Office Clerk
8048615182
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