Organization
INDEPENDENT HOMES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PASCAL THEBAUD (EXECUTIVE DIRECTOR)
(804) 721-1720
Entity
Organization
Contact information
Practice address
1816 ARCH ST, PETERSBURG, VA 23805-1618
(804) 721-1720
(804) 214-2177
Mailing address
PO BOX 3163, PETERSBURG, VA 23805-3163
(804) 721-1720
(804) 214-2177
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
139901001
VA
Other
Enumeration date
12/04/2011
Last updated
12/04/2011
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