Organization
PROVIDING EASE RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERITA JOHNSON (OWNER)
(804) 590-5706
Entity
Organization
Contact information
Practice address
218 LOCUST DR, WAVERLY, VA 23890-5027
(804) 590-5706
Mailing address
218 LOCUST DR, WAVERLY, VA 23890-5027
(804) 590-5706
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2
—
VA
Enumeration date
01/03/2023
Last updated
01/03/2023
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