Organization
DESTINY'S HOUSE RESIDENTIAL SERVICES, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICE MUHAMMAD (EXECUTIVE DIRECTOR)
(757) 903-4236
Entity
Organization
Contact information
Practice address
602 TAM O SHANTER BLVD, WILLIAMSBURG, VA 23185-5922
(757) 903-4236
Mailing address
602 TAM O SHANTER BLVD, WILLIAMSBURG, VA 23185-5922
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
990
VA
Other
Enumeration date
07/12/2008
Last updated
07/14/2008
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