Organization
SOUTHSIDE GROUP HOMES, LLC
Active
Other names
Southside Group Homes
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ANN ILAPIT (OWNER)
(757) 362-1479
Entity
Organization
Contact information
Practice address
3400 AIRLINE BLVD, PORTSMOUTH, VA 23701-2623
(757) 673-1483
Mailing address
3400 AIRLINE BLVD, PORTSMOUTH, VA 23701-2623
(757) 673-1483
(757) 405-6326
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0173726701
—
VA
05
—
0243633416
—
VA
05
—
0610652114
—
VA
05
—
0730265045
—
VA
Enumeration date
04/25/2019
Last updated
04/25/2019
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