Organization
FOURTH BAY VENTURES, LLC
Active
Other names
Owens Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN J. OWENS (VICE-PRESIDENT/TREASURER)
(757) 539-2245
Entity
Organization
Contact information
Practice address
166 S SARATOGA ST, SUFFOLK, VA 23434-5357
(757) 923-0480
Mailing address
106 NEWTOWN CT, SUFFOLK, VA 23434-9299
(757) 539-2245
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
VA
Other
Enumeration date
12/06/2007
Last updated
12/06/2007
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