Organization
BACK 2 BASICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLETTA PATRICE HIGHSMITH (OWNER/PROGRAM DIRECTOR)
(804) 326-9430
Entity
Organization
Contact information
Practice address
3808 CANDLEGROVE CT, RICHMOND, VA 23223-1440
(804) 228-2230
Mailing address
3808 CANDLEGROVE CT, RICHMOND, VA 23223-1440
(804) 228-2230
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
SS376/4051-07
VA
Other
Enumeration date
03/24/2008
Last updated
06/03/2008
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