Organization
FANNIE'S DIVINE MIRACLES,LLC
Active
Parent organization
FANNIE'S DIVINE MIRACLES,LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FANNIE'S DIVINE MIRACLES,LLC
Authorized official
IRISH CAINE (EXECUTIVE DIRECTOR)
(757) 729-0009
Entity
Organization
Contact information
Practice address
1100 HOLLADAY ST, PORTSMOUTH, VA 23704-2232
(757) 729-0009
(757) 966-5334
Mailing address
1100 HOLLADAY ST, PORTSMOUTH, VA 23704-2232
(757) 729-0009
(757) 966-5334
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1956
VA
Other
Enumeration date
10/28/2014
Last updated
10/28/2014
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