Organization
COMMONWEALTH RESIDENTIAL LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL WHITE (CEO)
(804) 253-5529
Entity
Organization
Contact information
Practice address
232 TARABY DR, SANDSTON, VA 23150-2148
(804) 921-4237
Mailing address
232 TARABY DR, SANDSTON, VA 23150-2148
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/16/2018
Last updated
09/16/2018
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