Organization
CRE8FORLIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHIRLEY DAVIS (CEO)
(757) 339-2995
Entity
Organization
Contact information
Practice address
149 NAUTICO WAY, PORTSMOUTH, VA 23703-5470
(757) 339-2995
Mailing address
149 NAUTICO WAY, PORTSMOUTH, VA 23703-5470
(757) 339-2995
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
VA
Enumeration date
02/03/2023
Last updated
02/03/2023
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