Organization
ANNZETTA'S THERAPEUTIC HOME FOR BOYS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY EMMA HARRIS (OFFICE CLERK)
(804) 861-5182
Entity
Organization
Contact information
Practice address
1834 BUCKNER ST, PETERSBURG, VA 23805-1705
(804) 863-2661
Mailing address
1834 BUCKNER ST, PETERSBURG, VA 23805-1705
(804) 863-2661
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/27/2007
Last updated
10/25/2007
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