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Organization
PRIMARY HABITAT LLC
Active
Organization
PRIMARY HABITAT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAYTON WRIGHT PHD (FOUNDER/CEO)
(704) 232-0063
Entity
Organization
Contact information
Practice address
610 MILE CREEK LN, CHESAPEAKE, VA 23322-1280
(704) 232-0063
Mailing address
610 MILE CREEK LN, CHESAPEAKE, VA 23322-1280
(704) 232-0063
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
12/25/2023
Last updated
12/25/2023
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