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Organization
INSEPARABLEGRP
Active
Organization
INSEPARABLEGRP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA SOWAH (OWNER)
(917) 890-0225
Entity
Organization
Contact information
Practice address
115 BOWMAN DR, SUFFOLK, VA 23434-2362
(917) 890-0225
Mailing address
115 BOWMAN DR, SUFFOLK, VA 23434-2362
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/15/2023
Last updated
11/15/2023
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