Organization
WEST LAKE RESIDENTIAL FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMIE JUNIOR PRATT (PRESIDENT)
(804) 560-9774
Entity
Organization
Contact information
Practice address
6946 FOREST HILL AVE, RICHMOND, VA 23225-1606
(804) 560-9774
(804) 560-9776
Mailing address
PO BOX 4506, MIDLOTHIAN, VA 23112
(804) 560-9774
(804) 560-9776
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
0459
VA
Other
Enumeration date
02/07/2007
Last updated
08/22/2020
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