Organization
CAMELLIA HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EPHAIM CRUZ (PRESIDENT/CEO)
(757) 227-1105
Entity
Organization
Contact information
Practice address
8027 CAMELLIA RD, NORFOLK, VA 23518-3416
(757) 227-1105
Mailing address
8027 CAMELLIA RD, NORFOLK, VA 23518-3416
(757) 227-1105
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2991
VA
Other
Enumeration date
08/25/2016
Last updated
10/15/2020
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