Organization
KEDA,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY HARDCASTLE (OWNER)
(804) 725-8624
Entity
Organization
Contact information
Practice address
143 MAPLE RD, MATHEWS, VA 23109-2139
(804) 725-8624
Mailing address
38 LITTLE ST, DUTTON, VA 23050-9732
(804) 725-8624
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
3205
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3205
DBHDS LIC.#
VA
Enumeration date
06/22/2018
Last updated
06/22/2018
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