Organization
HAMLET HOUSE YOUTH SERVICES, III LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GWENDOLYN SCURLOCK INGRAM (CHIEF ADMINISTRATIVE OFFICE)
(804) 326-9046
Entity
Organization
Contact information
Practice address
206 CARLSTONE DR, HIGHLAND SPRINGS, VA 23075-2503
(804) 326-9046
(804) 326-9046
Mailing address
517 CLAUSON RD, RICHMOND, VA 23227-1203
(804) 326-9046
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1347-14-001
VA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
1347-14-001
VA
Other
Enumeration date
08/28/2012
Last updated
08/28/2012
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