Organization
AN EXTENSION OF OUR FAMILY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANGELO RIVES (MANAGER)
(804) 479-5761
Entity
Organization
Contact information
Practice address
14810 ACORN RIDGE RD, MIDLOTHIAN, VA 23112-2302
(804) 479-5761
Mailing address
14810 ACORN RIDGE RD, MIDLOTHIAN, VA 23112-2302
(804) 479-5761
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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