Extended Love Agency Corp
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Newport News, VA. Organization (NPI-2).
NPI number1700131364
StatusActive
Last updated in NPPESJul 19, 2012
Details
- NPI
- 1700131364
- Entity type
- Organization (NPI-2)
- Legal business name
- Extended Love Agency Corp
- Organization subpart
- No
- Enumeration date
- Jul 19, 2012
- Last updated
- Jul 19, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | 1784 | VA | Yes |
Practice location
714 23rd StNewport News, VA 23607-4614
Phone 757-380-0433
Mailing address
714 23rd StNewport News, VA 23607-4614
Phone 757-380-0433
Authorized official
Jacqueline Hawkins
Owner
7573800433
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