Organization
BETHEL RESIDENTIAL HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LERLENA JEANETTE OLIVER M-DIV (DIRECTOR)
(804) 318-1349
Entity
Organization
Contact information
Practice address
14014 LIPPINGHAM CIR, CHESTER, VA 23831-6526
(804) 318-1349
(804) 318-1352
Mailing address
4625 TOOLEY DR, CHESTER, VA 23831-6636
(804) 318-9298
(804) 318-1352
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
1235
VA
Other
Enumeration date
09/19/2009
Last updated
09/19/2009
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