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Organization
HAMLET HOUSE YOUTH SERVICES, III LLC
Active
Organization
HAMLET HOUSE YOUTH SERVICES, III LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GWENDOLYN SCURLOCK INGRAM (CHIEF ADMINISTRATIVE OFFICE)
(804) 326-9046
Entity
Organization
Contact information
Practice address
206 CARLSTONE DR, HIGHLAND SPRINGS, VA 23075-2503
(804) 326-9046
(804) 326-9046
Mailing address
517 CLAUSON RD, RICHMOND, VA 23227-1203
(804) 326-9046
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1347-14-001
VA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
1347-14-001
VA
Other
Enumeration date
08/28/2012
Last updated
08/28/2012
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