Organization
GERTRUDE HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARENCE RUSSELL JR. (OWNER)
(757) 567-0923
Entity
Organization
Contact information
Practice address
7566 QUAKER DR, SUFFOLK, VA 23437-8906
(757) 567-0923
Mailing address
7566 QUAKER DRIVE, SUFFOLK, VA 23437-8906
(757) 567-0923
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2121
VA
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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